Emergency medicine journal : EMJ
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An otherwise healthy 92-year-old woman was admitted to our department with shortness of breath and dysphagia 10 h after a fall in her bathroom. Medical checkup at another institution had not uncovered the causation of the complaints. Clinical and radiological examinations at our department then revealed an expanding retropharyngeal and prevertebral haematoma. ⋯ Large retropharyngeal haematoma after minor blunt head and neck trauma is not a well-recognised condition. This case, however, illustrates that precarious retropharyngeal haematoma can occur after low-energy trauma even without anticoagulation therapy. A high index of suspicion for this airway collapse is advisable in older patients.
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Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. ⋯ Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.
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Controversies exist as to whether one should rely on the 'scoop and run' or 'stay and play' approach in the case of penetrating trauma in the prehospital setting. Optimal prehospital care is much debated and the extent to which advanced life support (ALS) measures should be performed remains unclear. This study aimed to report the outcome of penetrating torso trauma in relation to the on-scene time and ALS procedures performed prehospitally. It was hypothesised that a longer on-scene time could predict a higher mortality after penetrating torso trauma. ⋯ On-scene time might be important in penetrating trauma, and ALS procedures should not delay transport to definite care at the hospital.
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To determine the prevalence and nature of new clinically significant abdominal x-ray (AXR) findings and the proportion of patients receiving additional imaging in the emergency department (ED). ⋯ The yield for clinically useful information from the AXR is low and this investigation may be overused. Positive findings are associated mostly with bowel obstruction. As the proportion of patients ordered additional imaging was considerable, the utility of the preliminary AXR is questionable, especially in cases where the diagnosis is clear. Guidelines for AXR imaging are recommended to assist clinicians with investigation ordering.