Emergency medicine journal : EMJ
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This case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam. An initial anterior-posterior radiograph was obtained prior to referral to plastic surgery for further management (figure 1).emermed;36/2/65/F1F1F1Figure 1Clinical photographs and initial X-ray taken of the impalement injury.Clinical examination was restricted due to access. The patient reported general pain on limited movement of all digits but normal neurology. He received appropriate initial treatment of broad-spectrum antibiotics and tetanus care in the emergency department. His medical and social history were unremarkable. ⋯ What is the next most appropriate intervention?Immediate removal of the impaled structure under tourniquet control in an operating theatre.Immediate removal of the impaled structure in the emergency department under nerve block.Further imaging is needed.Urgent surgical consultation.
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Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians' decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. ⋯ When clinicians are faced with a diagnostic challenge, such as the workup of a patient with suspected SAH, there are a number of influencing factors that can result in a variation in approach. These need to be considered in approaches to improve the appropriateness and consistency of medical care.
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CLINICAL INTRODUCTION: A healthy 8-year-old boy presented to the ED with acute left shoulder pain. He had been playing football and his left arm was pulled by an opposition team member. He fell to the ground and landed on his left shoulder causing pain. ⋯ Acromioclavicular joint disruption. Intra-articular gas. Intra-articular loose body.
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Delayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis. ⋯ Our study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.