European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Lemierre's syndrome is characterised by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombophlebitis and isolation of an anaerobic pathogen. We present a case report and review the literature.
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This national survey was carried out to evaluate the quality programme for acute pain management in the emergency department (ED) and in pre-hospital emergency medical services (EMS). ⋯ Most ED and EMS units seem to master the quality control programme methodology. Units are highly motivated to initiate a quality control programme on pain. Nevertheless, its implementation could benefit from some external support.
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Syncope is a possible but little known presenting manifestation of acute pulmonary embolism (PE). The importance of syncope at the presentation of acute PE is not known. ⋯ Syncope is not an uncommonly presenting manifestation of acute PE. Patients with acute PE and syncope have similar characteristics to those without syncope. Syncope does not seem to determine a poor prognosis.
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The accuracy of scintigraphic evidence of perfusion defects, even when classified as 'high probability' by matching with ventilation techniques or thoracic roentenograms is unsatisfactory when used without a pre-test clinical evaluation of probability. Although unusual, a complete or near-complete unilateral absence of perfusion in a lung with normal perfusion controlaterally must alert clinicians to the possibility of a false-positive result. In such instances, the administration of therapeutic dosages of fibrinolitic and antithrombotic agents (or even surgery) may lead to deleterious consequences. We report a patient with malignancy causing extrinsic narrowing of the pulmonary artery leading to a drastic impairment in the perfusion of an entire lung, compatible with, but not diagnostic of massive pulmonary embolism.