Emergency medicine journal : EMJ
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Comparative Study
Characteristics of medication overdose presentations to the ED: how do they differ from illicit drug overdose and self-harm cases?
Medication overdose accounts for >80% of hospital presentations for self-harm. Previous research has identified typical characteristics of medication overdose cases; however, these cases have not been well differentiated from other similar presentations, namely (1) illicit drug overdose and (2) self-harm by means other than overdose. ⋯ On both demographic and treatment variables, patients attending the ED following a medication overdose more closely resemble those attending for self-harm by means other than overdose than those attending for illicit drug overdose.
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Balancing pressures of the 4-h wait in Accident and Emergency (A&E) and the National Institute for Clinical Excellence (NICE) requirement for a psychosocial assessment (PSA) before leaving hospital for patients presenting with self-harm is a challenge. This paper suggests a new method for coping with this demand. ⋯ This integrated care pathway (ICP) is evidence of true multidisciplinary working resulting in mutually beneficial outcomes for both the acute and mental health trusts.
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The Heimlich manoeuvre is well recognised worldwide as an emergency technique to clear an obstructed airway. The potential for serious injury to the choking victim is also well reported. ⋯ He eventually made a full recovery from his injury. However, we need to be aware of the possibility of injury in the rescuer as well as the rescued.
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Case Reports
Cardiac arrest secondary to type 2 Kounis syndrome resulting from urticaria and angioedema.
A 43-year-old man with no cardiac history presented with chest pain followed by cardiac arrest. He was successfully defibrillated and underwent primary percutaneous coronary angioplasty to a culprit coronary artery lesion. ⋯ Given the absence of cardiac symptoms before the development of the rash, it was hypothesised that coronary artery spasm precipitated by histamine release due to his dermatological condition contributed to his myocardial infarction and cardiac arrest. The final diagnosis was therefore cardiac arrest secondary to type II Kounis syndrome, resulting from idiopathic autoimmune or post-viral urticaria and angioedema.
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For analgesia and sedation in the paediatric setting, intranasal medication is favourable for several reasons, in particular ease of administration and rapid onset of action. A survey was conducted of all Emergency Departments in England and Wales regarding their use of intranasal medication in children. ⋯ Intranasal midazolam is used for sedation but is less well tolerated than when administered orally. Intranasal diamorphine, however, is safe and effective in the management of pain in the paediatric emergency setting and its ease of administration makes it ideal for use in the already traumatised child.