Emergency medicine journal : EMJ
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Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life-threatening emergencies. ⋯ Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality.
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We report the case of a patient who presented to the emergency with the common symptoms of chest pain and dyspnoea and who was subsequently found to have the rare diagnosis of a phaeochromocytoma. We highlight the need to maintain a high index of suspicion of the various differential diagnoses in any case presentation and the importance of trusting clinical intuition. We comment on the benefit of the use of emergency ultrasound.
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Case Reports
Neurological symptoms occurring in the context of ruptured abdominal aortic aneurysm: a paramedic's perspective.
Ruptured abdominal aortic aneurysm (RAAA) classically presents with sudden onset, severe ripping or tearing abdominal pain radiating through to the back. This case report describes features of an atypical presentation of a patient with RAAA and highlights the difficulties and uncertainties surrounding the prehospital assessment, appropriate treatment and management of these patients. All prehospital care educators and practitioners should be made aware of the wide spectrum of clinical manifestations for this condition.
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This article discusses the educational value of the "board round", a clinical teaching forum introduced at Hope Hospital, Manchester, UK. At midday on weekdays all available consultants and middle grade doctors, and any other staff who can attend, meet to discuss a case selected from the patients currently in the department. ⋯ In addition, attending a board round addresses in part the concerns which senior clinicians may have about the balance of service delivery and protected teaching time. The paper describes several other advantages of this method of teaching, which has been adopted by other hospitals in the region.