Emergency medicine journal : EMJ
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A 69-year-old woman presented to the ED with a chief complaint of recurrent vomiting for 3 weeks. She was afebrile, blood pressure was 100/67 mm Hg, HR was 114/min, RR was 19/min and oxygen saturation was 98%. On physical examination, she had mild epigastric tenderness without guarding. Blood tests were normal except for hyponatraemia of 128 mmol/L and hypokalaemia of 2.7 mmol/L. The ECG demonstrated sinus tachycardia with first-degree atrioventricular block. Chest radiograph posteroanterior view (CXR) was performed (figure 1).emermed;35/11/691/F1F1F1Figure 1Chest radiograph posteroanterior view. The patient presented to the ED with a complaint of recurrent vomiting for 3 weeks. ⋯ Due to continuous vomiting of this patient, which of the following is the most appropriate management?Abdominal ultrasonography.Chest and abdominal CT.Barium swallow.Oesophagogastroduodenoscopy (EGD). For answer see page 02 For question see page 01.
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The adolescent population comprises a significant proportion of attendances to the ED. Despite adolescent patients reporting lower levels of healthcare satisfaction compared with other age groups, their opinions are under-represented in existing literature. This prospective study investigated adolescents' expectations and preferences regarding the ED service. ⋯ Being 'seen quickly' was considered the single most important factor by adolescent patients in the ED. Notably, 'cleanliness' and aspects of communication also rated highly, with 'entertainment' regarded as least important. The additional insight into the healthcare preferences of the adolescent population provides a platform on which the future ED services can be tailored to the needs of young people.
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Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation. The aim of this study was, by a process of consensus, to develop an algorithm for the management of paediatric TCA for adoption in the UK. ⋯ In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first consensus-based algorithm specific to the paediatric population. While this algorithm was developed for adoption in the UK, it may be applicable to similar healthcare systems internationally.
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A short-cut review was carried out to establish whether haloperidol is effective at treating the symptoms of cannabinoid hyperemesis syndrome (CHS). One study was directly relevant to the question. ⋯ The clinical bottom line was that no controlled studies exist to report on the use of haloperidol. Alternative agents, used mainly off-label, show better promise at effectively treating symptoms of CHS based on case series and reports.