Emergency medicine journal : EMJ
-
Alcoholic ketoacidosis is a poorly diagnosed medical emergency usually identified in chronic alcohol misusers following an abrupt cessation or reduction of alcohol consumption. A high index of suspicion should be maintained by acute physicians as response to treatment is rapid with complete resolution of metabolic derangements. Complications are usually the result of not instituting the correct treatment or not addressing associated conditions. We describe a case of alcoholic ketoacidosis with multiple complications at presentation.
-
Review Case Reports
Compartment syndrome as a complication of a stab wound to the thigh: a case report and review of the literature.
Acute compartment syndrome of the thigh is a rare but potentially devastating condition, in which the pressure within the osseofascial compartment rises above the capillary perfusion gradient, leading to cellular anoxia, muscle ischaemia and death. Early diagnosis and treatment is essential to prevent long term disability. It is most often associated with crush injuries and femoral fracture. We present a previously unreported case of thigh compartment syndrome following a stab injury, treated by emergent fasciotomy.
-
A short cut review was carried out to establish whether warming local anaesthetic solutions reduced the pain on injection. A total of 758 papers were found using the reported search, of which 11 represented 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 best papers are presented in table 4. The clinical bottom line is that warming local anaesthetics, either alone or in combination with buffering, significantly reduces pain of local infiltration.
-
A short cut review was carried out to establish whether computed tomography (CT) is useful in the management of patients with suspected acute small bowel obstruction (SBO). A total of 348 papers were found using the reported search and manually cross referencing papers, of which 16 represented 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 best papers are presented in table 3. The clinical bottom line is that CT is a useful investigation in patients presenting with suspected SBO.
-
The use of telemedicine is becoming routine and accepted in certain limited areas such as electrocardiogram and radiograph/computed tomographic scan telemetry. Tele-education has thus far had limited applications although in emergency medicine it has been shown to be an effective medium for the education of senior house officers and emergency nurse practitioners in remote or peripheral units. Despite apparent clinical and cost benefits and government support, the full potential of two way video conferencing and tele-presence has yet to be realised by the clinician, educator and manager.