Emergency medicine journal : EMJ
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Consultation is a common and important aspect of emergency department (ED) practice which can lead to delays in patient flow. Little is known about ED consultations and this review systematically evaluated the literature on ED consultations. ⋯ Consultation research in the emergency setting is limited and variable; however, high consultation rates exist in some centres. This systematic review outlines the current state of the literature and suggests that further research is urgently needed.
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To establish the size of the population of patients presenting to a UK emergency department (ED) with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock and to determine their mortality and length of stay. ⋯ The high incidence of severe sepsis and septic shock with its attendant high mortality and length of stay is highlighted. If the figures are annualized, this would equate to 650 cases of severe sepsis or septic shock, of which 169 would die. The ED is well placed to improve this outcome by earlier detection and the use of goal directed therapy.
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We present a patient who complained of right flank pain resulting from spontaneous intercostal artery rupture while sleeping. He did not have symptoms or a history to suggest other diseases or trauma except hypertension. ⋯ To our knowledge, this is the second report in the literature documenting spontaneous intercostal artery rupture without associated illness or injury. Through comparison with the first reported case, we discuss the cause, the vulnerable site, and the treatment of spontaneous intercostal bleeding.
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To examine the efficacy of bolus dose intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained monomorphic ventricular tachycardia (VT). ⋯ Although advocated by advanced life support guidelines, bolus dose intravenous amiodarone was relatively ineffective for acutely terminating haemodynamically-tolerated sustained monomorphic VT with a significant incidence of haemodynamic destabilisation requiring emergency DCCV. Previous studies in the identical clinical setting suggest that alternative antiarrhythmic agents, particularly intravenous procainamide and sotalol, may be superior. A prospective randomised trial is required to determine the optimal drug treatment for stable sustained monomorphic VT in the emergency setting.