Emergency medicine journal : EMJ
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A 17-year-old male patient was brought by ambulance to the ED following a witnessed collapse while playing rugby. He denied any significant trauma, chest pain or breathlessness, and was alert and uncomplaining on arrival, with normal observations and a normal physical exam. Witnesses described a loss of consciousness, with a period of respiratory arrest requiring rescue breaths at the scene. Paramedics reported frequent ventricular extrasystoles on their arrival.The patient had no medical history and was on no medication, although admitted to 'fainting' some 3 weeks previously, again while playing rugby. A paternal uncle had died suddenly at the age of 45.His initial ECG is shown in figure 1.emermed;35/12/764/F1F1F1Figure 1Initial ECG. ⋯ What is the most likely diagnosis?Pulmonary embolism (PE)Hypertrophic obstructive cardiomyopathy (HOCM)Arrhythmogenic right ventricular cardiomyopathy (ARVC)Right ventricular outflow tract tachycardia (RVOT).
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Prehospital medical teams are commonly required to administer a range of medications for urgent stabilisation and treatment. The safe preparation of medications during resuscitation requires attention, time and resources, and can be a source of medication error. In our two road and HEMS (Helicopter Emergency Medical Service) prehospital services, medication errors are mitigated by predrawing commonly used medications to set concentrations daily (Hunter Retrieval Service, HRS) or second-daily (CareFlight Sydney, CFS). However, there are no published data confirming that such practice is microbiologically safe. ⋯ Predrawing of the eight studied medications for urgent prehospital procedures appears to be a microbiologically safe practice with syringe dwell times up to 48 hours.
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Patients presenting with chest pain represent a significant proportion of attendances to the ED. The History, ECG, Age, Risk Factors and Troponin (HEART) Score is validated for the risk stratification of suspected ischaemic chest pain within the ED. The goal of this research was to establish the interoperator reliability of the HEART Score as performed in the ED by different grades of doctor and nurse. ⋯ This study demonstrates very strong overall interoperator reliability between the four groups of clinicians studied. This suggests that the HEART Score is reproducible when used by different professional groups and grade of clinician.
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A short cut review was carried out to establish the rate and clinical characteristics of missed diagnosis of acute ischaemic stroke in the emergency department (ED). Two papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1 It is concluded that acute ischaemic stroke is missed in approximately 9%-14% of patients with this diagnosis who present to the ED. This is especially true in patients presenting with non-specific complaints such as dizziness, nausea/vomiting or altered level of consciousness.