Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2012
Cardiac troponin I does not independently predict mortality in critically ill patients with severe sepsis.
Patients with sepsis often have elevated cardiac troponin I even in the absence of coronary artery disease. The prognostic value of cardiac troponins in critically ill patients with sepsis remains debatable. Our objective was to evaluate the prognostic value of cardiac troponin I in critically ill patients with severe sepsis. ⋯ Critically ill patients with severe sepsis who had elevated troponin had increased hospital and intensive care mortality. However, cardiac troponin I did not independently predict hospital mortality.
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Twenty-five years on from the first fellowship examination of the College, it is timely to reflect on the issue of clinical longevity. The pressures of the emergency medicine workplace are relatively unique among the medical specialties, and might require unique solutions if emergency physicians are to continue clinical practice in the latter stages of their careers.
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Emerg Med Australas · Apr 2012
Case ReportsCase report on vertebral artery dissection in mixed martial arts.
A 41-year-old man presented to the ED with severe vertigo 2 days after a grappling injury while training in mixed martial arts. Imaging revealed a cerebellar infarct with complete occlusion of the right vertebral artery secondary to dissection. Management options are discussed as is the ongoing controversy regarding the safety of the sport.
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Abdominal pain can be a challenging presenting complaint with a broad differential diagnosis. Medication side-effect must always be considered. Visceral angio-oedema secondary to angiotensin-converting enzyme inhibitor use can cause abdominal pain. ⋯ The epidemiology of angio-oedema is now changing in parallel with the increasing use of angiotensin-converting enzyme inhibitors. We present a case of visceral angio-oedema secondary to perindopril. This diagnosis requires a high index of suspicion because if not recognized early patients undergo extensive and expensive negative evaluation.