Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether emergency department (ED) based brief intervention is worthwhile in adults presenting with alcohol related events. A total of 590 papers were found using the reported search, of which eight 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 1. The clinical bottom line is that brief psychotherapeutic intervention is worthwhile in adults who attend the emergency department after an alcohol related event.
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To assess the value of a near-patient brain natriuretic peptide (BNP) test to predict medium term (3 month) serious outcome for adult syncope patients presenting to a UK emergency department (ED). ⋯ This early work suggests that BNP may have a role in the risk assessment of syncope patients in the ED. Further work is required to see how BNP interacts with other clinical variables. Near-patient BNP testing may be shown to be an independent predictor of adverse outcome either alone or incorporated into existing syncope clinical decision rules and scores in order to improve their sensitivity and specificity. Further studies are required to evaluate this.
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To compare the various paediatric weight estimation methods (Advanced Pediatric Life Support, Broselow Tape, Argall, and Best Guess) and parental estimate to measured weight. ⋯ Parental estimation of weight is more accurate than the other weight estimation methods studied. When this is not available, the Broselow tape is the most accurate alternative method.
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Case Reports
Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.
Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.
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There are consensus guidelines on the appropriate use of gut decontamination in the management of poisoned patients. This study demonstrates that few doctors have read these guidelines and that they have poor knowledge of the use of gut decontamination, which can be improved with specific clinical toxicology teaching. Future guidelines should be published in journals more widely read by those doctors treating poisoned patients.