Emergency medicine journal : EMJ
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Spontaneous pneumothoraces are a common thoracic problem presenting to an Accident and Emergency (A&E) department. The symptoms and signs are well described and a chest x-ray examination is usually diagnostic. ⋯ Further, its presence makes a tensioning pneumothorax, or as in this case a pneumothorax with significant collapse and apical adhesions, more likely. No previous case reporting the association has had the opportunity for thorascopic assessment and demonstration of likely cause.
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Brugada syndrome is one of the important causes of sudden cardiac death in young adults. The condition is associated with typical ECG changes in anteroseptal leads V1 and V2 that can be unmasked by various medications, electrolyte disturbances, and even by the febrile state in susceptible individuals. The case history is reported of a patient with atrial flutter and atrial fibrillation who developed Brugada-like ECG changes when treated with propafenone. ⋯ A review of previous ECGs showed the temporal relationship of ECG changes to initiation of propafenone a few years earlier. The ECG changes resolved with discontinuation of propafenone and re-emerged when he was rechallenged with oral propafenone. This case highlights the importance of recognising the characteristic ECG changes of Brugada syndrome and being able to differentiate them from those of acute myocardial infarction and other conditions manifesting with similar changes.
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To assess changes in basic ophthalmic training of accident and emergency (A&E) senior house officers (SHOs) in the last 10 years, their own perceived level of confidence and the availability of appropriate equipment in their departments. ⋯ A&E departments are better equipped with slit lamps 10 years on, and staff are being trained to use them. This has unfortunately not improved the confidence levels in dealing with eye emergencies, reflecting the lack of adequate basic ophthalmic training for A&E SHOs. Recent changes in postgraduate medical training could provide a platform to bring about the changes required.
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Comparative Study
Comparison of characteristics of admitted emergency department patients requiring cardiopulmonary resuscitation in the ICU and non-ICU setting.
Hospitalised patients requiring cardiopulmonary resuscitation (CPR) have better outcomes in intensive care units (ICUs) than wards. Survival could potentially be improved for patients at high risk for CPR if they can be identified while in the emergency department (ED) and admitted to an ICU setting. It is currently unknown whether patients requiring CPR who are admitted to the ward show a similar pattern of physiological deterioration to those admitted to the ICU, and thus whether future research should consider these two patients groups as distinct. It is hypothesised that, since both groups of patients decompensate to the point of requiring acute resuscitation shortly after hospital admission, they should also share similar premonitory signs of deterioration in their basic physiological parameters. ⋯ This study indicates that patients who experience CPR after admission to non-ICU wards may have a different pattern of physiological deterioration from patients admitted to an ICU. Further studies to derive decision criteria in admitting patients at risk for inpatient CPR should treat these patient populations as separate.