Emergency medicine journal : EMJ
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This study aimed to determine the extent of agreement between central venous and arterial values for pH, bicarbonate, base excess, and lactate in a group of intensive care unit (ICU) patients. ⋯ Central venous pH, bicarbonate, base excess, and lactate values showed a high level of agreement with the respective arterial values, with narrow 95% limits of agreement. These results suggest that venous values may be an acceptable substitute for arterial measurement in this clinical setting.
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Case Reports
Complete atrioventricular block and ventricular tachyarrhythmia associated with donepezil.
Donepezil is a reversible inhibitor of acetylcholinesterase. Its commonest adverse events are nausea, diarrhoea, malaise, dizziness, and insomnia. Symptomatic cardiac rhythm disturbances associated with the use of donepezil are extremely unusual. ⋯ Treatment of AD with cholinesterase inhibitors carries a risk of cardiac disturbances. In addition to sinusal bradycardia, it may lead to such major dysrhythmias as complete atrioventricular block and ventricular tachyarrhythmia, as in our case. In this report, we describe symptomatic complete atrioventricular block and ventricular tachyarrhythmia associated with the use of donepezil.
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Death rates are an outcome that can be used to describe a service. We measured three death rates that can be used to describe an emergency department (ED): death rates for those seen in the ED and discharged, those that die within the ED, and those that die after admission. We also wanted to establish how easy it was to obtain these rates and how frequently autopsy was performed. ⋯ These three death rates were easy to calculate and could be used to describe the outcome of an ED service. Further research to establish the range of rates for different departments is now required to determine their potential use.
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Modernising Medical Careers (MMC) is a project designed to reconfigure postgraduate medical education throughout the United Kingdom. It is proposed that all UK medical school graduates undertake a 2 year foundation programme to build basic professional skills to which specialist training can be added. ⋯ In the case of emergency medicine, a common stem of training in emergency and critical care is being proposed which would be suitable early training for potential specialists in emergency medicine, anaesthesia, intensive care, and acute medicine. In both foundation training and higher specialist training, the trainee should have the skills of a self directing, reflective learner and the trainer the skills required to produce a good learning environment with a supportive and open atmosphere and learning structured to maximise the opportunities for experiential learning in the workplace.
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Syncope is a commonly encountered problem in the emergency department (ED). Its causes are many and varied, some of which are potentially life threatening. A review was carried out of relevant papers in the available literature, and this article attempts to assimilate current evidence relating to ED management. ⋯ Patients with unexplained syncope who have significant cardiac disease should therefore be investigated thoroughly to determine the nature of the underlying heart disease and the cause of syncope, although presently there is little evidence that this improves their dismal prognosis. This risk stratification approach has led to the development of several clinical decision rules, which are discussed along with current international guidelines on syncope management. This review suggests that presently the American College of Emergency Physicians guidelines are the most useful aids specific to the management of syncope in the ED; however, the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score may also be a useful ED risk stratification tool.