Emergency medicine journal : EMJ
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A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. ⋯ Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.
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To evaluate the effects of change of ambient temperature on emergency department (ED) patient visits. ⋯ Our study demonstrated that ambient temperature had differential effects on ED patient visits of different specialties and severities.
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A review was performed looking at the first 100 intubation procedures performed or solely supervised by one emergency medicine trainee. Over the 5 year period during which the procedures were performed the author performed 93 and supervised 7 procedures. There were 90 rapid sequence intubation procedures and 10 intubations without drugs. ⋯ This study suggests that as a trainee gains experience in performing intubation procedures, the nature of the complications arising changes. Initial complications involved misplacement of the tube, whereas later complications involved not obtaining an adequate view, latterly in increasingly difficult airways. Truly difficult airways are not common and may not be experienced until much later in a trainee's career.
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Capnometry is a non-invasive monitoring technique which allows fast and reliable insight into ventilation, circulation, and metabolism. In the prehospital setting it is mainly used to confirm correct tracheal tube placement. ⋯ It helps to confirm the diagnosis of pulmonary thromboembolism and to sustain adequate ventilation in mechanically ventilated patients. In patients with haemorrhage, capnometry provides improved continuous haemodynamic monitoring, insight into adequacy of tissue perfusion, optimisation within current hypotensive fluid resuscitation strategy, and prevention of shock progression through controlled fluid administration.
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Multicenter Study
Validation of a diagnostic reminder system in emergency medicine: a multi-centre study.
Diagnostic error is a significant problem in emergency medicine, where initial clinical assessment and decision making is often based on incomplete clinical information. Traditional computerised diagnostic systems have been of limited use in the acute setting, mainly due to the need for lengthy system consultation. We evaluated a novel web-based reminder system, which provides rapid diagnostic advice to users based on free text search terms. ⋯ The Isabel diagnostic aid has been shown to be of potential use in reminding junior doctors of key diagnoses in the emergency department. The effects of its widespread use on decision making and diagnostic error can be clarified by evaluating its impact on routine clinical decision making.