European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study Comparative Study
Upper gastrointestinal haemorrhage in Emergency Departments in France: causes and management.
Little is known about the epidemiology of acute upper gastrointestinal haemorrhage hospitalized in Emergency Departments. Most of the studies concerning digestive bleeding have been carried out by Gastroenterology Departments. This multicentre study included consecutive patients with acute upper gastrointestinal haemorrhage hospitalized after an initial management at Emergency Departments in France, to describe the initial medical management and to determine the causes of acute upper gastrointestinal haemorrhage. We also studied the relationship between the use of non-steroidal anti-inflammatory drugs or aspirin and the occurrence of an acute upper gastrointestinal haemorrhage by a case-control comparison. ⋯ Hospitalized acute upper gastrointestinal haemorrhage in Emergency Departments in France is more often caused by cirrhosis than in other countries. Decreasing the delay between the first signs of bleeding and arrival at the Emergency Department is the main challenge in the management of acute upper gastrointestinal haemorrhage.
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To compare patient, guardian and professional assessment of acute pain in children presenting to an Emergency Department, and to examine whether there was a correlation between the scores obtained using the Faces and linear scales for each group. ⋯ Professionals score pain lower than do children or guardians. Similar pain scores are obtained using both a Faces and a linear scale. This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting.
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Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. We report a 10-year-old girl with Down syndrome with asthma bronchiale symptoms, which was later found to be the result of a thin bone lamella impacted in her larynx. There was no clear history of foreign body aspiration. ⋯ The foreign body was removed via direct laryngoscopy. It was a white and thin bone lamella with sharp edges, measuring 28 x 19 x 2 mm. We thought the case was worth presenting because of its rare location, the size of the foreign body, and the long duration before the final diagnosis was made.
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To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. ⋯ In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.
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Diaphragmatic rupture is an uncommon and frequently missed complication in blunt thoraco-abdominal trauma. Symptoms usually become apparent in a delayed phase, up to years after the trauma. ⋯ We only found two cases in the literature. We present here two other cases from our practice, with a review on the literature on post-traumatic diaphragmatic hernias.