Emergency medicine journal : EMJ
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Gastric perforation in association with incarceration of a hiatus hernia rarely features on a list of differential diagnoses of acute chest pain. A patient presented to the emergency department with acute chest pain characteristic of myocardial ischaemia. Several risk factors for ischaemic heart disease (IHD) were present. ⋯ Her postoperative course was complicated by pulmonary and intra-abdominal sepsis necessitating admission to the intensive care unit where she remained for 23 days. This case highlights the challenge that non-cardiac chest pain presents to the acute care physician. Patients who present with risk factors for and symptoms consistent with a diagnosis of IHD may have non-cardiogenic pathology which can be life-threatening.
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The Bradford Burn Study: the epidemiology of burns presenting to an inner city emergency department.
The Bradford Burn Study prospectively reviewed all burn attendances at a single emergency department in the UK over a 1 year period. The study reviewed the epidemiology, demographics and outcomes of all patients entered into the study. ⋯ Emergency departments manage patients with burns well, and referrals to plastic surgery departments are appropriate. The majority of burns can be prevented by addressing educational issues and vulnerable sections of the population.
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To establish the accuracy of the emergency medical dispatcher's (EMD's) decisions to override the automated Medical Priority Dispatch System (MPDS) logic-based response code recommendations based on at-scene paramedic-applied transport acuity determinations (blue-in) and cardiac arrest (CA) findings. ⋯ This study contradicts the belief that EMDs can accurately perceive when a patient or situation requires more resources than the MPDS's structured interrogation process logically indicates. This further strengthens the concept that automated, protocol-based call taking is more accurate and consistent than the subjective, anecdotal or experience-based determinations made by individual EMDs.
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Mad honey poisoning is well known in the eastern Black Sea region of Turkey. The cause of the poisoning is the toxin grayanotoxin, found in honey obtained from the nectar of Rhododendron species on the mountains in the region. A 60-year-old man was brought to the emergency department with dizziness and syncope after eating a few spoonfuls of honey. ⋯ The patient was given 0.5 mg of atropine, and asystole began and ended. The patient was transferred to the catheter laboratory and a temporary pacemaker was implanted. Mad honey poisoning related asystole has not been previously reported, and the rapid response to atropine is significant.
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To determine if peripheral intravenous cannula dead space is taken into account when setting up intravenous infusions (in particular nitrate infusions) in the emergency department. ⋯ Knowledge of peripheral intravenous cannula dead space in UK emergency departments is very poor and, as a result, there is probably significant widespread under treatment of patients in severe cardiogenic pulmonary oedema. Departments should amend their treatment guidelines to take account of peripheral cannula dead space.