Emergency medicine journal : EMJ
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To assess the relationship between reported chest pain symptoms and a diagnosis of acute coronary syndrome (ACS) and serious cardiopulmonary diagnoses (SCPD) in black males, white males, black females and white females. ⋯ Chest pain symptoms are important predictors of ACS and SCPD in certain combinations of race and gender but less so in others. These differences might explain difficulties using symptoms to identify patients at higher or lower risk of ACS and SCPD in practice.
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A short cut review was carried out to establish whether corticosteroids are safe and effective in managing the symptoms of acute gouty arthritis. Five studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that corticosteroids are an effective and safe alternative to non steroidal anti inflammatory drugs (NSAIDs) in patients presenting with acute gouty arthritis.
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Age influences survival from an out-of-hospital cardiac arrest (OHCA) but it is unclear to what extent. Improved understanding of the impact of increasing age may be helpful in improving decision making on who should receive attempted resuscitation to optimise outcomes and minimise inappropriate end-of-life management. Our aim is to describe the demographics, characteristics and outcomes following resuscitation attempts in OHCA patients aged 70 years and older in Ireland. ⋯ In those aged 70 years and older, the rate of survival to hospital discharge declined with increasing age group. Younger age, an initial shockable rhythm and witnessed arrest were independent predictors of survival to hospital discharge.
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A 51-year-old male presented to the ED with a rash to his left thigh (figure 1) with erythema, swelling and pain. He endorsed paraesthesias, pruritus, fevers, vomiting and diarrhoea. Initial vitals were unremarkable. He was well appearing with an 8×8 cm violaceous patch on his left medial thigh with vesicles, surrounding erythema and induration with a second, smaller lesion on the right thigh. Both rashes were extremely tender.emermed;34/10/686/F1F1F1Figure 1Erythematosus and vesicular rash in bilateral legs.A bedside ultrasound image of the rash was obtained (figure 2).emermed;34/10/686/F2F2F2Figure 2Bedside ultrasound of rash. ⋯ What is the most likely cause of the patient's rash?A. Herpes zosterB. CellulitisC. Necrotising fasciitisD. Bullous pemphigoid.
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A 44-year-old woman, with an unremarkable medical history, presented in the middle of the night with discomfort in her throat. She described being assaulted by an assailant who put his 'fist in her mouth', trying to suffocate her. On examination, she had normal observations and no signs of injury, other than scratch marks around her mouth; she reported no odynophagia and was able to swallow fluids readily. During examination, she complained that lying flat made her increasingly uncomfortable and was causing burgeoning dyspnoea. She had lateral soft tissue radiography of her neck as shown in figure 1.emermed;34/10/676/EMERMED2016205919F1F1EMERMED2016205919F1Figure 1Lateral neck soft tissue radiograph of the 44-year-old woman. ⋯ What is the diagnosis? Caustic stricture of the oesophagusPharyngeal perforationPharyngeal pouchBoerhaave's syndrome.