European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Prompt and correct treatment of broad complex tachycardias in the emergency department can often be life-saving to the patient and satisfying for the emergency physician. They, however, are often a diagnostic challenge. Here, we present a case of posterior fascicular ventricular tachycardia, an idiopathic form of ventricular tachycardia that occurs in patients without coronary artery disease and verapamil sensitive. The differential diagnoses of posterior fascicular ventricular tachycardia and supraventricular tachycardia with aberrancy will also be discussed.
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Comparative Study
A cadaveric study of complications associated with the subxiphoid and transthoracic approaches to emergency pericardiocentesis.
The aim of this cadaveric study was to compare three commonly used approaches for emergency pericardiocentesis and to determine the safest approach. ⋯ The SXP1 approach appeared to be the safest, followed by anterior transthoracic intercostal pericardiocentesis. The SXP2 approach caused the highest amount of complications, resulting from the needle entering the abdominal cavity. The presence of intra-abdominal pathology and the possibility of post-mortem changes in the position of the diaphragm, however, might have been a causative factor in this finding.
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Letter Case Reports
Analgesia and sedation in the presence of a naltrexone implant: a novel pharmacological challenge.
In chronic opioid abusers, sedation and analgesia present challenges. We describe two trauma patients with naltrexone implants (depot micro-receptor antagonists that facilitate opioid withdrawal) requiring intensive care. The first patient, a 28-year-old man, sustained chest and pelvic injuries when hit by a motor vehicle. ⋯ Propofol, tramadol and paracetamol proved effective. We wish to notify colleagues of the existence of these implants as they are increasingly widely used, and should be considered when encountering severe opioid resistance. Secondly, their role in managing opioid-dependent physicians appears promising.
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The paper refers to the problem of emergency medical service in Poland, which is the only European Union Member State not having activated the emergency phone number 112. This fact has caused the threat of European Union sanctions. ⋯ The necessary law was enacted in 2001, but it did not come into force. The threat of European Union sanctions may hasten its implementation; however, the weak position of the present government may cause a further delay of the reform.