Emergency medicine journal : EMJ
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The aim of this study was to develop an evidence-based guideline for use primarily by junior clinicians to assist with the management of children presenting to the hospital with an acute breathing difficulty. ⋯ We have developed an evidence-based guideline that has subsequently been successfully implemented in the paediatric emergency departments and disseminated nationally. Results showing the effect of the guideline upon practice will be published separately.
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Pneumothorax is a common presentation to the emergency department, arising from traumatic and non-traumatic aetiologies. Diagnosis of non-tension pneumothorax is by a visible lung edge on chest radiography together with the absence of lung markings more peripherally. The Advanced Trauma Life Support (ATLS) system recommends tube thoracostomy as the definitive treatment for traumatic pneumothorax. The case is described of a patient who presented following thoracic trauma with an unusual finding on chest radiography that led to diagnostic confusion by mimicking a pneumothorax.
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In the emergency department (ED), clinicians can benefit greatly from having access to information at the point of care. It has been suggested that using computerised information systems could improve the accessibility of information. However, making information accessible, while maintaining confidentiality, is one of the main challenges of implementing information systems. This article presents the ED staff perspectives about the accessibility and confidentiality of information in the ED. ⋯ To design a system, the accessibility and confidentiality of information should be addressed in parallel. A balance between these two is needed, as the failure of each of these may negatively influence the use of the system.
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Randomized Controlled Trial Multicenter Study
Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram.
Clinical features may be used to determine which patients with suspected acute coronary syndrome (ACS), but a normal or non-diagnostic ECG, should be selected for further investigation or inpatient care. We aimed to measure the diagnostic value of clinical features for ACS. ⋯ Clinical features have very limited value for diagnosing ACS in patients with a normal or non-diagnostic ECG. Radiation of pain to the right arm increases the likelihood of ACS.