Emergency medicine journal : EMJ
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Case Reports
Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis.
Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. We report a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. ⋯ The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound.
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Comparative Study
Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre.
To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. ⋯ Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.
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Practice Guideline
Prehospital anaesthesia in the UK: position statement on behalf of the Faculty of Pre-hospital Care.
Prehospital anaesthesia is carried out regularly by a small number of prehospital care practitioners in the UK. Although mostly predictable, prehospital procedures can be more difficult than those in hospital, and, in addition, peer and skilled anaesthetic assistance is usually not available. Patient safety is of paramount importance, and systems need to be in place to ensure that the highest standards are achieved.
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Human bite injuries are both deceptive and challenging in their presentation and management. They remain a frequent presentation to our unit, most often following late night alcohol fuelled aggression. ⋯ Human bite wounds present a challenge to any emergency department, given the many issues involved in their management. Underestimation of the complexity and potential sequelae of these wounds will result in a suboptimal outcome for the patient.
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Randomized Controlled Trial Multicenter Study
Structure, process and outcomes of chest pain units established in the ESCAPE trial.
Chest pain units (CPUs) provide a system of care for patients with acute chest pain that can improve outcomes while reducing health service costs. The Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) multicentre trial was undertaken to determine whether CPUs could be successfully established throughout the National Health Service (NHS). ⋯ CPU care can be instituted in a safe manner at a variety of NHS hospitals, with most patients being discharged after assessment. However, there is variation in the number and type of patients managed by the different units. Further research is required to identify reasons for variation in CPU activity.