Emergency medicine journal : EMJ
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Randomized Controlled Trial
Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial.
To determine if intravenous paracetamol was superior to oral paracetamol as an adjunct to opioids in the management of moderate to severe pain in the ED setting. ⋯ Overall, there was a small but clinically significant decrease in pain in each group. No superiority was demonstrated in this trial with intravenous paracetamol compared with oral paracetamol in terms of efficacy of analgesia and no difference in length of stay, patient satisfaction, need for rescue analgesia or side effects.
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Review Historical Article
Brief history of the specialty of emergency medicine.
This is a brief overview of the development of the specialty of Emergency Medicine from small beginnings fifty years ago. It describes how the specialty evolved simultaneously in the UK and the USA and later in Australasia and Europe.
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To identify differences in prevalence, demographics, clinical features and outcomes for type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI) in a cohort of patients presenting to the Emergency Department (ED) with chest pain. ⋯ T2MIs comprised one quarter of all MIs diagnosed in the ED. Among patients presenting to the ED with symptoms of ACS, symptoms do not allow clinicians to reliably differentiate patients with T1MI and T2MI. Prior hypertension, tachycardia and abnormal non-ischaemic ECGs are seen more often in T2MI compared with T1MI. One-year mortality was substantial in patients with T1MI and T2MI, but low power precludes conclusions about mortality differences between groups.
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The Accreditation Council for Graduate Medical Education (ACGME) is the governing body responsible for accrediting graduate medical training programme in the USA. The Emergency Medicine Milestones (EM-Milestones) were developed by the ACGME and American Board of Emergency Medicine as a guide and monitoring tool for the knowledge, skills, abilities and experiences to be acquired during training. Alumni surveys have been reported as a valuable resource for training programme to identify areas for improvement; however, there are few studies regarding programme improvement in emergency medicine. We aimed to use the EM-Milestones, adapted as an alumni self-assessment survey, to identify areas for training programme improvement. ⋯ Alumni self-evaluation of competence using the EM-Milestones provides valuable information concerning confidence to practice independently; these data, coupled with regular milestone evaluation of existing trainees, can identify problem areas and provide a blueprint for targeted programme improvement.
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CLINICAL INTRODUCTION: A 29-year-old keen parachutist presented to the emergency services in Cyprus complaining of sudden-onset facial flushing, dizziness and a widespread rash. The episode began on a hot day, 1 hour after she had eaten a breakfast of tinned tuna, and while she was ascending in an aircraft to parachute from 10 000 ft. She completed her jump uneventfully. She had no significant medical history (figure 1).emermed;35/3/184/F1F1F1Figure 1Patient's legs on presentation; this rash was generalised.