European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Acute appendicitis, the most common cause of abdominal surgical emergency, shows a different pathogenesis, clinical course and outcome in the elderly. Age-specific factors are effective on preoperative clinical diagnosis and on the stage of this infectious disease. We aimed to present our experience with a series of elderly patients with appendicitis who were subjected to appendectomy. ⋯ Postoperative morbidity and mortality is unacceptably high. Advancing age adversely affects clinical diagnosis, the stage of disease and the outcome of patients. Perforated appendicitis and septic progression is the main cause of undesirable outcomes.
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The objective of this study was to evaluate the success rates of endotracheal intubation of trauma patients by emergency physicians and to determine if there are areas in which the care of these patients could be improved. This was a retrospective observational study of 142 major trauma patients who required advanced airway management. The median age was 32 years and 74% of the patients were men. ⋯ The pretreatment of head-injured patients with lignocaine was performed in only six out of 66 indicated cases (9.1%). The complication rate was 23.2%. Hypotension occurred in 22.9% of cases treated with midazolam, and was more common than in those who were intubated without a sedating agent [odds ratio (OR) 3.108; 95% confidence interval (CI) 1.060, 9.109].
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To determine the current use of beta2-agonists, in particular salbutamol, for the management of acute asthma in children in emergency departments throughout Australia and New Zealand. ⋯ We report a wide variation of salbutamol use in paediatric emergency departments and a high prevalence of type A adverse drug reactions when continuous-infusion intravenous salbutamol therapy was administered. More evidence is needed on the clinical significance of the adverse effects reported in this study and optimal doses for the safe use of continuous-infusion intravenous salbutamol therapy in paediatric emergency departments.
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Persistent scalp swelling following blunt head injury may be the presenting feature of a pseudoaneurysm of the temporal artery. This paper describes three patients who sustained injuries to the temporal region, which resulted in the formation of pseudoaneurysms. All patients had a delayed presentation to the Emergency Department. We describe their clinical presentations, subsequent management and pitfalls encountered when dealing with this condition.
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Case Reports
Acquired C1-esterase inhibitor deficiency: a rare cause of episodic acute abdominal pain and ascites.
C1-esterase inhibitor deficiency is a rare yet classic medical cause of acute abdominal pain mimicking a surgical emergency. A hereditary form and a very rare acquired form of the disease exist, and both give rise to a similar clinical syndrome despite a different pathogenic mechanism. We describe a typical case of acquired C1-esterase inhibitor deficiency in a 65-year-old woman presenting with recurrent acute abdomen and ascites who had undergone two negative surgical interventions before diagnosis was eventually established. Both the diagnostic and therapeutic approach to this rare condition should be known by emergency physicians for two reasons: (1) it may present as an acute abdominal emergency resulting in unnecessary surgical intervention; and (2) it may cause life-threatening upper airway obstruction as a result of laryngeal oedema.