Emergency medicine journal : EMJ
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The diagnosis of pulmonary embolism demands flexible decision models, both for the presence of clinical confounders and for the variability of local diagnostic resources. As Bayesian networks fully meet this requirement, Bayes Pulmonary embolism Assisted Diagnosis (BayPAD), a probabilistic expert systems focused on pulmonary embolism, was developed. ⋯ BayPAD offers clinicians a flexible and accurate strategy to diagnose pulmonary embolism. Simple to use, the system performs case-based reasoning to optimise the use of resources available within a particular hospital. Bayesian networks are expected to have a prominent role in the clinical management of complex diagnostic problems in the near future.
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Multicenter Study
Bupivacaine in the emergency department is underused: scope for improved patient care.
To determine patterns of local anaesthetic use, knowledge and perceived use of local anaesthetic by emergency department doctors, and barriers to bupivacaine use. ⋯ Bupivacaine seems to be underused in some appropriate circumstances. Accordingly, there is scope for improvement in patient care through critical evaluation of local anaesthetic practice. This is particularly necessary because barriers to bupivacaine use are often non-clinical (habit, availability, familiarity) rather than clinical (toxicity, onset time).
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Low-flow priapism is a rare condition whereby there is a persistent, painful erection. The patient often presents late because of embarrassment. ⋯ A case of low-flow priapism, that demonstrated a lack of urgency and understanding is discussed. An internet-based literature search provided a treatment regimen with resolution of tumescence.
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Review Case Reports
Life-threatening episode after ingestion of toad eggs: a case report with literature review.
It is known that toad possesses several toxic substances in the skin and parotid glands. In the past, toad-venom poisoning had been reported from ingestion of toad soup, Kyushin and aphrodisiac pills, but the poisoning from toad eggs is observed for the first time. The case of a healthy female who had previously eaten toad soup twice without any discomfort is reported. She developed gastrointestinal symptoms and life-threatening cardiac rhythm after ingestion of toad eggs.
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To describe the population of emergency department patients who leave without being seen by a medical officer, to investigate the circumstances of their visit and to ascertain whether they subsequently receive alternative medical care. ⋯ The number of patients who leave an emergency department without seeing a doctor is strongly correlated with waiting time for medical review. Achieving shorter emergency department waiting times is central to reducing the numbers of people leaving without being seen. The rate of patients who leave without being seen is also strongly correlated with triage category. These findings highlight the importance of accurate triaging, as this clearly influences waiting time. It is also likely that there are patients who benefit from the reassurance of the triage assessment, and therefore feel less urgency for medical review. These may be cases where immediate medical review is not essential. This area should be further explored. These results are important for planning and staffing health services. Decision makers should identify and target factors to minimise walkouts from public hospital emergency departments.