Emergency medicine journal : EMJ
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Review Case Reports
Critical care in the emergency department: acute kidney injury.
Acute kidney injury (AKI) is common among emergency department patients admitted to hospital. There is evidence of inadequate management of the condition leading to adverse outcomes. We present an illustrative case of AKI complicating a gastrointestinal disorder in an older adult. We discuss the clinical presentation, assessment and management of AKI with reference to recent consensus guidelines on classification and treatment.
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A short-cut review was carried out to establish whether a precordial thump might be effective in restoring a perfusing heart rhythm in patients with pulseless VT or VF. Forty-seven papers were found in using the reported searches. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that using the precordial thump in out-of-hospital cardiac arrest rarely results in immediate return of spontaneous circulation and is more commonly associated with rhythm deterioration.
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A short-cut review was carried out to establish whether prehospital adrenaline affects long-term morbidity or mortality after out-of-hospital cardiac arrest. Fifty-five papers were found using the reported search. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that while epinephrine used as an adjunctive treatment during out-of-hospital cardiac arrest (OHCA) may improve return of spontaneous circulation (ROSC) and survival to hospital, it does not improve survival to discharge or neurological outcome.
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Observational Study
The incremental value of stress testing in patients with acute chest pain beyond serial cardiac troponin testing.
In patients with acute chest pain and normal range cardiac troponin (cTn), accurate risk stratification for acute coronary syndrome is challenging. This study assesses the incremental value of stress testing to identify patients for angiography with a view to revascularisation. ⋯ ACTRN1260900028327, ACTRN12611001069943.