Emergency medicine journal : EMJ
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A shortcut review was carried out to establish whether intravenous glucagon is a safe and effective treatment for patients with suspected lower oesophageal food bolus impaction. Seven studies were directly relevant to the question. ⋯ Its use may be associated with adverse effects such as vomiting, with the potential risk of oesophageal perforation. Intravenous glucagon should therefore be avoided.
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Physicians are called upon to teach students, residents, patients and their families in the clinical environment every day as part of clinical care. A fast-paced emergency department offers a unique set of challenges that require the physician to be an effective communicator. We present a top 10 list of ideas selected from the literature for the busy clinician to use on that next shift to improve bedside teaching.
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Anaphylaxis in children presents most frequently with respiratory features, and concern exists about the potential for diagnostic confusion with acute asthma. 84 cases of asthma requiring intensive care were identified. 11 cases met exclusion criteria, which left 73 cases for analysis using established anaphylaxis diagnostic criteria. 13/73 children (17.8%) were found to have sufficient clinical features for a diagnosis of anaphylaxis to be entertained, with 3/73 cases (4.1%) considered highly likely to be anaphylaxis. This study highlights the potential for diagnostic confusion and demonstrates the need to consider anaphylaxis in all children presenting with severe asthma.
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Observational Study
Characterising emergency department high-frequency users in a rural hospital.
Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses. ⋯ These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.
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The hypothesis of the present work derives from clinical experience that suggests that patients who are more ill have less facial expression variability in response to emotional cues. ⋯ With a single visual stimulus, patients with serious cardiopulmonary diseases lacked facial expression variability and surprise affect. Our preliminary findings suggest that stimulus-evoked facial expressions from emergency department patients with cardiopulmonary symptoms might be a useful component of gestalt pretest probability assessment.