European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
Predictive validity comparison of two five-level triage acuity scales.
Each of the two most commonly used five-level triage tools in North America, the Emergency Severity Index and the Canadian Triage and Acuity Scale have been used as a measure of emergency department resource utilization in addition to acuity. In both cases, it is believed that patients triaged as having a higher level of acuity require a greater number of emergency department resources. We compared the ability of each tool to predict the emergency department resources for each emergency department visit and associated hospital admission and in-hospital mortality rates. ⋯ No statistically significant difference was observed in the ability of Emergency Severity Index v. 3 and Canadian Triage and Acuity Scale to predict emergency department resource utilization or immediate patient outcomes. This ability is, at best, only moderate indicating that other, more accurate tools than measures of triage acuity are required for this purpose.
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The impact of prolonged work cycles among senior doctors remains disputed. We evaluated the effects of overnight duty on awake activity and sleep quality in senior doctors in emergency medical specialties. ⋯ On-call night work in acute specialties induces sleep debt associated with prolonged impairment of awake activity, sleep quality and performance. Not working the following day after an on-call night allows partial recovery of sleep quality to begin.
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Comparative Study Clinical Trial
Comparison of troponin I and N-terminal-pro B-type natriuretic peptide for risk stratification in patients with pulmonary embolism.
We compared the usefulness of plasma N-terminal-pro B-type natriuretic peptide and troponin I levels for risk stratification of patients with pulmonary embolism. ⋯ Unlike troponin I, N-terminal-pro B-type natriuretic peptide may be an accurate marker of in-hospital complication after pulmonary embolism.
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Penetrating laryngeal traumas due to gunshot wounds are rare cases. These cases are generally encountered during wars. Here, we report a 40-year-old man who presented with a gunshot wound in his neck. ⋯ The patient had a good recovery without any symptom postoperatively. Early recognition and accurate management of penetrating laryngeal traumas are essential. Establishing a patent airway and a good quality of voice are important aims for long-term results.
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A case report of a 27-year-old man who developed significant hypotension and ischaemic ECG changes as a result of a disulfiram ethanol reaction. He was treated with intravenous fluids and norepinephrine, which has been advocated as the pressor agent of choice. This case highlights the potential dangers of disulfiram, a drug that can be beneficial in the short term, but not proven to improve long-term outcome in the treatment of alcoholism.