Emergency medicine journal : EMJ
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Necrotising myositis is a surgical emergency. It is underappreciated that it may present without changes in the skin. ⋯ Remarkable features were the absence of skin signs and the rapidity with which the patient became extremely septic. A review of the literature has shown the importance of early diagnosis and quick decision making to minimise mortality.
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Recent evidence shows a substantial short-term risk of ischaemic stroke after transient ischaemic attack (TIA). Identification of patients with TIA with a high short-term risk of stroke is now possible through the use of the "ABCD Score", which considers age, blood pressure, clinical features and duration of symptoms predictive of stroke. ⋯ In this retrospective analysis, dichotomising the ABCD Score was overinclusive but highly predictive in identifying patients with TIA at a high short-term risk of stroke. Use of the ABCD Score in the emergency care of patients with TIA is simple, efficient and provides a unique opportunity to prevent stroke in this population of patients.
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The Lund University Cardiopulmonary Assist System (LUCAS) is a gas-driven mechanical cardiopulmonary resuscitation device. If oxygen is used as the driving gas in a confined environment, there is a potential fire hazard. 24% oxygen is considered the threshold for increased risk. ⋯ The LUCAS is safe for normal-duration flights in an MD902 helicopter. It is potentially unsafe in a static MD902 and, by extrapolation, in other static aircraft of similar or smaller size such as the EC135 or Bolkow 105.
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To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. ⋯ The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non-qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.