Emergency medicine journal : EMJ
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Vertigo is not an uncommon presentation to the emergency department. It is most commonly caused by benign peripheral processes, such as inner ear or vestibular nerve dysfunction, but can be due to central brain lesions. ⋯ VAD is increasingly being recognised as an important cause of stroke in young people. We discuss the important features that need to be elicited to distinguish central from peripheral disease and the relevance of VAD.
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We present a case of a patient with a seemingly insignificant single gluteal stab wound which led to a solitary perforation of the ileum and delayed peritonitis. This case report illustrates that, despite the absence of any signs of bowel perforation on presentation, a patient may deteriorate gradually in the subsequent hours. This demonstrates the role of clinical observation in high risk gluteal stab wound patients.
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To review the causes of death in patients admitted via the emergency department (ED) who died within 7 days of admission and to identify any ways in which ED care could have been better. The study also aims to compare the diagnosis made in the ED and the mortality diagnosis. ⋯ The ED is playing a good role in the management of critically ill patients, with appropriate diagnosis and management in 82% of cases. Training of junior doctors is required to prevent occurrence of errors and thus preventable deaths, but all deaths are not preventable. New guidelines for sepsis management and management of undifferentiated clinical presentations are being introduced and we intend to audit the implications of new guidelines.
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As trainee numbers and the geographical spread of training departments have increased, the model of weekly face-to-face teaching has come under strain because of long travel times. This has been compounded by a reduction in the total number of hours worked by trainees. Furthermore the traditional teacher centred educational programme has been challenged as unfit for purpose on grounds of both content and style. ⋯ The principles outlined in this paper are widely applicable and will be of interest to all clinical educators within the specialty, both within the UK and overseas.
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To perform a risk analysis study to determine the probability of a spinal fracture being of malignant origin in patients presenting at a level I trauma centre emergency room after trauma. ⋯ Supported by the present results we feel the probability of malignant fractures, although not frequently encountered, should always be considered in elderly and middle-aged patients with a history of malignancy and a non-cervical traumatic fracture.