Emergency medicine journal : EMJ
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The objectives of this prospective observational study were to: (1) determine the accuracy of physician diagnosis in patients with an acutely altered mental status (AMS) within the first 20 min of emergency department (ED) presentation; and (2) access if physician confidence in early diagnosis correlates with accuracy of diagnosis. ⋯ Early diagnoses of AMS patients are moderately accurate. Few early misdiagnoses of AMS patients were clinically relevant. Physicians' greater degree of confidence in their diagnosis correlated with greater accuracy.
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To evaluate the utilisation of paper-based track and trigger (T&T) charts in a UK emergency department (ED). ⋯ T&T in the ED is challenged by poor completion rates and numerical errors made during score calculation. However the potential for recognition of a deteriorating patient should not be ignored. The future work of the authors intends to evaluate an electronic system for automatically calculating T&T scores within the ED environment.
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The scaphoid bone is the most commonly fractured carpal bone. MRI is now recognised to be more sensitive and specific than serial plain films in the diagnosis of occult scaphoid fracture. What is not known is whether it is safe to discharge, without follow-up, those with a normal limited extremity MRI. The primary objective of this study was to determine whether a normal limited scaphoid MRI safely excludes clinically significant injury. The secondary objectives were to determine morbidity and patient experiences of those without fracture on MRI. ⋯ This study shows that limited extremity MRI can safely exclude clinically important injury. Significant symptoms do persist, however, for many patients with a normal MRI.
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Rescue efforts for earthquakes in remote plateau regions require large numbers of professional personnel to be transported from various lowland regions for relief work. Unacclimatised rescuers to high-altitude regions commonly suffer acute mountain sickness (AMS), which makes relief efforts inefficient and potentially dangerous. ⋯ Given the ineffectiveness of prophylactic measures and the urgency of such disaster situations, it is unrealistic to mobilise rescue teams from lowland regions for immediate relief efforts. A local disaster plan specific to plateau earthquakes needs to be developed with local personnel for timely and efficient relief.