Emergency medicine journal : EMJ
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Practice Guideline
The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh.
This paper provides a guideline for the management of prehospital chest injuries after a consensus meeting held by the Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK, in January 2005. An overview of the prehospital assessment, diagnosis and interventions for life threatening chest injury are discussed, with the application of skills depending on the training, experience and competence of the individual practitioner.
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Case Reports
Hypokalaemia and sudden cardiac death--lessons from implantable cardioverter defibrillators.
The cases of four patients experiencing ventricular arrhythmia secondary to drug-induced hypokalaemia requiring treatment by a previously implanted cardioverter defibrillator (ICD) are reported here. In three cases, hypokalaemia developed within a short period of time after modification of diuretic regimen with loop and thiazide diuretics had been carried out or potassium-sparing drugs had been withdrawn. ⋯ The fact that the combination of thiazide and loop diuretics can be associated with pronounced hypokalaemia and life-threatening arrhythmias, which may be terminated by device treatment in patients with an ICD but may be fatal in patients with structural heart disease but without an ICD, is highlighted here. Prompt recognition and correction of hypokalaemia is mandatory if such patients present to the emergency department.
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We report the case of a 13-year-old boy presenting with profound bradycardia following minor trauma. Our patient had gastroschisis at birth and has moderate learning difficulties but is otherwise fit and well. Whilst playing at home he fell sustaining a minor cervical hyperextension injury. ⋯ On discharge the patient was advised to wear a cervical hard collar when mobilising. This association of a craniocervical abnormality with learning difficulties, and gastroschisis has not been previously described. We discuss several other causes of odontoid peg instability, which may lead to severe autonomic effects with relatively insignificant trauma.
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The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. ⋯ Emergency physicians should consider Wegener's granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
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The effect of storage temperature on the stability of two succinylcholine chloride solutions (20 and 50 mg/ml) was evaluated. Molecular composition was analysed using nuclear magnetic resonance spectroscopy. ⋯ The corresponding monthly degradation rates for the two solutions were 0.18% and 0.30% when stored at 4 degrees C, and 5.4% and 8.1% when stored at 37 degrees C. If a 10% loss of potency is considered acceptable, then the 20 and 50 mg/ml succinylcholine solutions can be stored in emergency resuscitation carts at room temperature for 8.3 and 4.8 months, respectively.