European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Wound botulism is a rare infectious disease due to neurotoxin release from the anaerobic, spore-forming bacterium Clostridium botulinum that is becoming an ever more frequent complication of parenteral drug abuse in the Western world. Before the year 2000, no such cases had been reported in the UK and Ireland, but since then the number of proven and suspected cases of wound botulism occurring in parenteral drug users has increased markedly. ⋯ This is the case report of a male heroin user who presented three times to an Emergency Department in the UK before a diagnosis of wound botulism was made and treatment commenced. It is important that emergency clinicians are aware of the possibility of wound botulism in parenteral drug users that present with unusual neurological or respiratory symptomatology.
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To raise awareness of the possibility of carbon monoxide poisoning as a diagnosis in the emergency department and to present the little known fact that it is possible to diagnose carbon monoxide poisoning retrospectively. ⋯ Carbon monoxide poisoning is common but often goes unrecognized. This method may help to decrease the number of overlooked cases and thereby possibly prevent further exposure and acute or chronic sequelae.
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The incidence and prevalence of imported disease within the emergency department is not known. It is known, however, that a significant number of patients attend medical practitioners after they return from travelling. If practitioners working in emergency departments are unaware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will remain undiagnosed in the acute setting. ⋯ It appears that medical practitioners in emergency departments do not routinely establish a travel history, or consider the diagnosis of imported disease, when presented with a clinical scenario that describes a possible imported disease. Consequently, there is a high potential for imported disease to be missed in the emergency department.
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A case of paediatric aortic dissection is reported. The pathogenesis, investigation and treatment are discussed. We highlight that the history and nature of the pain should alert clinicians to this condition and that baseline investigations may be normal.