Emergency medicine journal : EMJ
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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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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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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.
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Diabetic muscle infarction (DMI) is a rare complication of longstanding, poorly controlled diabetes. Only a few cases have been reported in the literature. The case of a 34-year-old man with a 7-year history of type 2 diabetes mellitus, with sudden onset of left thigh pain, is described here. ⋯ Short-term prognosis is very good; however, the recurrence rate is high. Long-term prognosis is poor, with most patients dying from cardiovascular complications of diabetes within 5 years of diagnosis. This case supports the need for a high index of suspicion, when a poorly controlled patient with diabetes presents with non-traumatic limb pain.