European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To investigate whether co-existing medical disorders, summed up in a comorbidity index, in nonsurgical patients attending the emergency department could predict short-term and long-term mortality, and whether the index could add prognostic information to the Rapid Emergency Medicine Score. ⋯ Information on coexisting disorders (Charlson Comorbidity Index) can prognosticate both short-term and long-term mortality in the nonsurgical emergency department. It can also add prognostic information to the Rapid Emergency Medicine Score as a predictor of long-term mortality.
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The aim of this study was to identify pitfalls in the acute management of ankle fractures which were referred to a regional orthopaedic unit. This unit provides orthopaedic services for the catchment area of the Waterford Emergency Department together with three additional emergency units in the south-eastern region of Ireland. ⋯ Ankle fractures are a common musculoskeletal injury seen in emergency departments and minor injury units. Long-term disability resulting from ankle fractures can be reduced by optimal early management procedures. This is an important area for consideration in education programmes in emergency medicine.
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The use of alternative medicines is increasing and poorly regulated. We describe a case of severe cyanide poisoning arising from amygdalin, a putative vitamin supplement. A 32-year-old woman arrived in the emergency department by ambulance unresponsive, shocked and with fixed dilated pupils. ⋯ Serum thiocyanate level was markedly elevated. She recovered fully over 8 h. While various antidotes to cyanide exist, in this case supportive therapy alone proved effective.
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We describe a case of an eupnoeic patient complaining of a foreign body sensation in his mouth and throat, with sudden drooling and supine gagging. This condition was caused by an isolated uvular angioedema (Quincke's oedema). ⋯ Isolated uvular oedema is a potentially life-threatening condition with risk of sudden upper airway obstruction, and should therefore be recognized and treated as soon as possible. As described in this case, its initial presentation can consist of gagging and drooling without dyspnoea, thus causing a real challenge for triage and diagnosis.
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Case Reports
Accidental intravenous administration of racemic adrenaline: two cases associated with adverse cardiac effects.
Accidental intravenous administration of racemic adrenaline (epinephrine) is a rare but potentially lethal complication. We describe a case of a 68-year-old man with chronic obstructive pulmonary disease who developed severe dyspnoea at home, and a case of an 81-year-old woman who had an allergic reaction associated with severe dyspnoea. ⋯ Previous reports of accidental intravenous administration of racemic adrenaline are also reviewed. We discuss the potential risks of using racemic adrenaline, especially in the treatment of geriatric patients, and the possibilities of reducing the risk of accidents in drug administration.