Emergency medicine journal : EMJ
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A 63-year-old women with a history of palpitations presented to the emergency department with a supraventricular tachycardia; the patient was cardiovascularly stable. Carotid sinus massage (CSM) was performed to help identify the underlying rhythm. During massage the patient had an immediate cerebrovascular accident, resulting in a left hemiplegia. Given the prevalence of atherosclerotic vascular disease in the general population and the safe alternatives available, it is recommended that CSM not be used for the termination of narrow complex tachycardia in the elderly population.
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At this 35 000 visits/year emergency department (ED) at a level one trauma centre, a trauma protocol was implemented for the ED observation unit. Data on all trauma observation unit admissions were then collected to evaluate for safety, efficiency and admission rates. ⋯ The observation unit is a safe alternative to inpatient admission for the evaluation of the minimally injured trauma activation patient.
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ED transthoracic ultrasound is better than plain x ray in the diagnosis of pneumothorax in the supine patient. CT thorax is the gold standard for diagnosis.
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As many as half the patients presenting with acute stroke access medical care through the ambulance service. In order to identify and triage these patients effectively as life-threatening emergencies, telephone-based ambulance software must have high sensitivity and specificity when using verbal descriptions to identify such patients. Software-based clinical coding was compared with the patient's final clinical diagnosis for all patients admitted by ambulance to North Hampshire Hospital (NHH) emergency department (ED) over a 6-month period to establish the ability of telephone-based triage to identify patients with likely stroke accurately. ⋯ Fewer than half of all patients with acute stroke were identified using telephone triage on the initial emergency call to the ambulance service. Less than one quarter received the highest priority of ambulance response. This first link in the chain of survival needs strengthening in order to provide prompt and timely emergency care for these patients.
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Children who harm, hurt or kill themselves are a significant issue for health professionals in emergency departments (ED), with over 60 000 young people presenting to ED in the UK each year following self-harm. ⋯ A paediatric triage tool was developed that allows the more appropriate triage of young people who harm themselves and is acceptable to all stakeholders involved in their care.