Emergency medicine journal : EMJ
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Cervical spine injuries in paediatric patients following trauma are extremely rare. The National Emergency X-Radiography Utilization Study (NEXUS) guidelines are a set of clinical criteria used to guide physicians in identifying trauma patients requiring cervical spine imaging. It is validated for use in children. A case of a child who did not fulfil the NEXUS criteria for imaging but was found to have a cervical spine fracture is reported.
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The ABCD scoring system has been described as a simple way of predicting stroke in the first 7 days after a transient ischaemic attack (TIA). The aims of our pilot study were to find out if emergency department (ED) doctors could use the scoring system effectively and if this system would influence admission rates and patient selection. ⋯ The ABCD scoring system for identifying high-risk patients after TIA is a useful aid in determining which patients require admission from the ED. Its use results in a significant reduction in the number of admissions without any inappropriate discharges.
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Acute cardiac tamponade requires urgent diagnosis and treatment. We report a case involving a 70-year-old man who was receiving warfarin treatment for 12 years following mitral valve replacement. The international normalised ratio (INR) was checked and echocardiography performed regularly in the clinic. ⋯ An intravenous vitamin K injection and fresh frozen plasma transfusion were administered to reverse the patient's over-anticoagulated state. The final pathology revealed chronic inflammation and there was no malignancy, and no bacteria or mycobacterium were seen. Emergency physicians should remember that over-anticoagulation with warfarin may contribute to certain complications, including haemopericardium, and that strict control of target INR should be the goal for patients who require continuous warfarin treatment.