Emergency medicine Australasia : EMA
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Increased awareness of idiopathic hypertrophic pyloric stenosis (IHPS) and readily available ultrasonographic diagnosis might mean that 'classic' presentations are becoming less common. We sought to describe the epidemiology, clinical features and outcomes of children with IHPS in the modern era. A retrospective case review of all cases of IHPS presenting to a single tertiary paediatric hospital over an 11 year period was conducted. ⋯ IHPS occurs more frequently in male and ex-premature infants. It commonly presents without the full spectrum of 'classic' symptoms and signs. Given the availability of ultrasound diagnosis, IHPS should be considered in all babies with any one of the classic findings.
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Emerg Med Australas · Aug 2009
What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?
Ketamine has become the drug most favoured by emergency physicians for sedation of children in the ED. Some emergency physicians do not use ketamine for paediatric procedural sedation (PPS) because of concern about emergence delirium on recovery. The present study set out to determine the true incidence and nature of this phenomenon. ⋯ The belief that ketamine, in the doses used for ED PPS, causes frequent emergence delirium is flawed. A pleasant emergence phenomenon is common, but is not distressing for the child, and has no long-term (up to 30 days) negative sequelae. Rarely, there is anxiety or distress on awakening from ketamine sedation, which settles spontaneously. This should not deter emergency physicians from using ketamine for PPS.
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Emerg Med Australas · Aug 2009
Multicenter StudyEmergency Department diagnosis of pulmonary embolism is associated with significantly reduced mortality: a linked data population study.
We characterized patients admitted via ED with a principal hospital discharge diagnosis of pulmonary embolism (PE) and compared mortality of those diagnosed in the ED with those diagnosed after admission. ⋯ Making the diagnosis of PE in ED was associated with a substantial survival advantage that persisted after hospital discharge.
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Emerg Med Australas · Aug 2009
Emergency Department management of Colles-type fractures: a prospective cohort study.
To assess radiographic outcomes from ED reduction of Colles-type fractures. ⋯ The study highlights the importance of the initial 'on arrival' and 'post-reduction' X-rays in the ED. Displaced fractures are more likely to go onto poor outcome, as are inadequately reduced fractures. Medical officers working in ED should be aware of the importance of measuring the dorsal angle. They should be referring patients with >15 degrees dorsal angulation to orthopaedics early. Reduction should not be accepted until the dorsal angle has been adequately corrected.