Emergency medicine journal : EMJ
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Comparative Study
Prevalence of cocaine use among patients attending the emergency department with chest pain.
Cocaine is the only drug to show a rise in misuse between 1996 and 2007 in England and Wales. It can cause chest pain and myocardial infarction. This study assessed the prevalence of cocaine use in patients presenting with chest pain, and determined the association between cocaine use and chest pain. ⋯ As many patients do not admit to use of an illegal drug, routine testing would enable cocaine-related ischaemic events to be identified more easily but this remains controversial. As management of cocaine-induced chest pain is different from other causes of chest pain, doctors should routinely question patients with chest pain about cocaine use in addition to well recognised risk factors.
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A case of amisulpride overdose is presented and its effect on prolonging the QT (corrected) interval is discussed. Amisulpride is used for the treatment of schizophrenia and part of its safety profile is that is has no effect on the QT interval in therapeutic doses. The efficacy of intravenous calcium in restoring the QT to normal is proposed.
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The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma. ⋯ In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.
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Posterior reversible encephalopathy syndrome is a recently described clinicoradiological entity. Neuroimaging is very demonstrative and can be the first clue to the diagnosis. ⋯ Its pathogenesis remains poorly understood. Clinical findings are not sufficiently specific; however, neuroimaging is often characteristic.