European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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A 25-year-old woman presented with chest pain. Electrocardiogram (ECG) on admission was normal. When she had recurrent chest pain a second ECG showed marked ST elevation in the anteroseptal leads. ⋯ The case illustrates several important points. Inquiring about risk factors in patients with chest pain should include a question about abnormal clotting. It is important to exclude significant pathology in patients who may appear 'histrionic': inspection of a patient's belongings and collateral history may be invaluable.
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Comparative Study
Return visits to the emergency room after minor trauma from motor vehicle accidents.
Most patients with minor trauma following motor vehicle accidents (MVAs) are discharged from the emergency room (ER) of a trauma centre after evaluation and observation. Some return with similar or additional symptoms. This study aimed to determine which patients returned, if any injuries had been missed, and what should be the policy of medical management. ⋯ However, in none of the patients was the initial diagnosis revised nor were additional injuries found and consequently the initial management was not changed in any of them. It is concluded that the initial thorough evaluation by the primary traumatologist is adequate for MVA patients with minor trauma. These patients do not require any follow up in specialized clinics, and are best managed in the community by their general practitioners.
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We report a patient who had headache and neck pain after whiplash injury and subsequently developed cerebellar infarction due to vertebral artery dissection. This patient's pain was out of proportion to his apparent injury and it was a clue to the final diagnosis. ⋯ Detailed cranial nerve and cerebellar examination should be performed for detection of circulatory insufficiency. Discharge advice for patients should also include that of stroke or transient ischaemic attack.