European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Atrial fibrillation (AF) causes numerous visits to emergency departments (EDs). We evaluated the thromboembolic and bleeding risk profile and use of oral anticoagulation (OAC) therapy among patients presenting with symptomatic AF to ED. ⋯ These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
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Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. ⋯ The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
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To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome. ⋯ Overt DIC is a rare but underdiagnosed event in ED patients. In this collective, cardiac arrest is a dominant cause of DIC presenting with a fibrinolytic phenotype. The degree of hypofibrinogenaemia on admission strongly and linearly predicted early death.
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Endovascular treatment for acute ischemic stroke with a large intracranial occlusion was recently shown to be effective. Timely knowledge of the presence, site, and extent of arterial occlusions in the ischemic territory has the potential to influence patient selection for endovascular treatment. We aimed to find predictors of large vessel occlusive strokes, on the basis of available demographic, clinical, radiological, and laboratory data in the emergency setting. ⋯ Neurological deficits, stroke risk factors, and CT findings accurately identify acute ischemic stroke patients at risk of symptomatic vessel occlusion. Predicting the presence of these occlusions may impact emergency stroke care in regions with limited access to noninvasive vascular imaging.
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Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events. ⋯ By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.