Emergency medicine journal : EMJ
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A clinically suspected scaphoid fracture with normal initial plain x-rays is a difficult but common problem. The role of MRI as a diagnostic modality in this situation was analysed based on the experience of 611 consecutive cases. ⋯ MRI is a useful and effective tool in the diagnosis of radiologically occult wrist injuries. It is feasible to do MRI scans in a timely manner in a district general hospital.
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Emergency physicians frequently undertake emergency procedural sedation in non-fasted patients. At present, no UK guidelines exist for pre-procedural fasting in emergency sedation, and guidelines from the North American Association of Anesthesiologists (ASA) designed for general anaesthesia (GA) are extrapolated to emergency care. A systematic review of the literature was conducted with the aim of evaluating the evidence for risk of pulmonary aspiration during emergency procedural sedation in adults. ⋯ Furthermore, ASA guidelines for fasting prior to GA are based on questionable evidence, and there is high-level evidence that demonstrates no link between pulmonary aspiration and non-fasted patients. There is no reason to recommend routine fasting prior to procedural sedation in the majority of patients at the Emergency Department. However, selected patients believed to be significantly more prone to aspiration may benefit from risk:benefit assessment prior to sedation.
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Hypoglycaemia leading to altered consciousness level in patients with diabetes is a commonly encountered problem in the emergency department. Prompt diagnosis and the institution of appropriate therapy usually results in a significant improvement in the patient's condition. ⋯ However, the limitations of this test are not widely known. This case report draws attention to spuriously normal glucose readings with a capillary blood glucose evaluation device in certain patients who have significant hypoglycaemia confirmed on arterial blood gas analysis and laboratory venous blood analysis.
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There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. ⋯ The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidence-based interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services.