Emergency medicine journal : EMJ
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There is considerable variation in the standard of initial burn management, particularly burn surface area assessment and application of resuscitation formulae. Early aggressive management of major burns improves survival. Internationally, the Parkland formula employing lactated Ringer's solution is used for fluid resuscitation. This study aimed to assess whether Parkland fluid resuscitation tables could improve the accuracy of initial fluid requirement calculations. ⋯ The use of Parkland fluid resuscitation tables can improve accuracy and ease of calculation of fluid resuscitation requirements.
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To describe the demographics of patients from care homes who attend the emergency department (ED) and to estimate whether appropriate alternative care pathways could have been delivered to this patient group. ⋯ In this study between 8% and 40% of patients could have been cared for outwith the ED. The findings highlight the importance of the provision of appropriate healthcare to care home residents and the current deficits that exist.
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Case Reports
Caveats in the management and diagnosis of cerebellar infarct and vertebral artery dissection.
Early MRI, available 24 h a day and at weekends, will make a timely diagnosis in cases of cerebellar infarct and a normal initial CT scan does not exclude it. In many emergency departments MRI is not as routinely available out of hours as CT. It is important to appreciate the varied symptomatology and signs of cerebellar infarcts in order to avoid misdiagnosis or delayed diagnosis and to remember that, apart from requiring treatment with anticoagulation for the cerebellar infarct itself, the complications of cerebellar infarct may require surgical intervention. Vertebral artery dissection as a cause of cerebellar infarct may require anticoagulation or endovascular therapy.
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There is a significant literature examining the reasons why patients attend emergency departments frequently. This body of work suggests that sociodemographic characteristics are important in understanding why patients re-attend, but it does not provide a definition of what frequent attendance means. This paper aims to identify personal and attendance factors associated with frequent attendance at an emergency department. ⋯ Where local services are being designed to divert frequent attenders, existing data sources can be a rich source of information to inform service design. For example, this analysis identifies older men at their fourth or more attendance as a potentially important group when examining frequent attendance at this particular hospital. It also identified a potential need for services outside normal surgery hours, although frequent attenders tend to be triaged into the more urgent categories.
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Delayed diagnosis of pyogenic liver abscess remains a challenging problem in the emergency department because of the associated high morbidity and mortality. ⋯ The size and location of the liver abscess and the underlying comorbid diseases may affect the diagnostic sensitivity of ultrasound for pyogenic liver abscess in clinical practice. A high index of suspicion should be maintained in patients with diabetes mellitus, previous biliary tract intervention or gastrointestinal malignancy. Follow-up CT scanning is recommended if right flank knocking pain is present, even if ultrasonography is non-revealing. A diagnostic protocol for liver abscess may be feasible in the future.