Emergency medicine journal : EMJ
-
A 67-year-old man presented to the acute medical take with a history of droopy eyelids and difficulty swallowing. A diagnosis of myasthenia gravis was suspected from the clinical history. The patient's symptoms were progressive, raising concerns of aspiration pneumonia or respiratory compromise if untreated. ⋯ The ice-test is a straightforward and non-invasive investigation with a high sensitivity for myasthenia gravis and is a useful alternative to edrophonium testing. It is especially helpful in patients with cardiac and respiratory co-morbidities for whom acetylcholinesterase inhibitors are contraindicated. We describe a case where this simple bedside test successfully expedited the correct treatment and improved patient care.
-
This paper follows previous publications on generic qualitative approaches, qualitative designs and action research in emergency care by this group of authors. Contemporary views on mixed methods approaches are considered, with a particular focus on the design choice and the amalgamation of qualitative and quantitative data emphasising the timing of data collection for each approach, their relative 'weight' and how they will be mixed. Mixed methods studies in emergency care are reviewed before the variety of methodological approaches and best practice considerations are presented. The use of mixed methods in clinical studies is increasing, aiming to answer questions such as 'how many' and 'why' in the same study, and as such are an important and useful approach to many key questions in emergency care.
-
A short-cut review was carried out to establish whether patients requiring lower limb immobilisation should have thromboprophylaxis. A total of 148 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. ⋯ The clinical bottom line is that ambulatory patients with temporary lower leg immobilisation who are over 50, in a rigid cast, non-weight bearing or with a severe injury should be considered as an at risk group for venous thromboembolism (VTE). If there are any other current proven VTE risk factors, patients should be considered as high risk.