European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Epistaxis is a common ear, nose and throat emergency. A variety of nasal packs are available to control the bleeding by tamponade. Training of junior doctors to insert nasal packs is difficult when dealing with a bleeding patient. We discovered a readily available and simple model to enable trainees to learn the method of nasal packing.
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Review Case Reports
Acute compartment syndrome secondary to diabetic muscle infarction: case report and literature review.
Acute compartment syndrome has a multitude of aetiologies. Unfortunately, the diagnosis is often delayed, resulting in permanent functional loss. Although spontaneous muscle infarction is an uncommon, yet well-recognized complication of diabetes mellitus, subsequent development of compartment syndrome appears to be rare, with only five case reports identified in the literature. ⋯ We report a case of a diabetic gentleman who presented with lower limb pain significantly out of proportion to any obvious injury and had a subsequent diagnosis of acute compartment syndrome. Despite fasciotomies, he had a persistent foot drop. Nontraumatic acute compartment syndrome secondary to diabetic muscle infarction should be considered in any diabetic patient presenting with pain out of proportion to sustained injury.
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The management of acute temporomandibular joint dislocation relies on the traditional method, which involves intraoral manipulation of the mandible on both sides of the patient. Often, intravenous sedative or analgesic agents are needed to facilitate closed reduction. In this report, the authors introduce a new approach called the ipsilateral approach, in which extraoral or intraoral manipulation of the dislocated side is performed to accomplish closed reduction, without using sedatives or analgesics. Three methods, namely, extraoral, intraoral and combined, are described. ⋯ This ipsilateral approach, using extraoral and intraoral methods, is cost-effective, simple and convenient for the management of acute temporomandibular joint dislocation.
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As access to computed tomography scanning has become easier, patients with a lower probability of serious pathology are being scanned. We asked how many lumbar punctures need to be performed to detect each subarachnoid haemorrhage in these lower-risk patients. ⋯ In patients who have a low pre-computed tomography probability of subarachnoid haemorrhage and undergo an early computed tomography scan, the risk/benefit ratio of lumbar puncture is unclear. A decision rule (risk stratification system) might improve our ability to help the patient make an informed choice.
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Although blood cultures are commonly ordered in the emergency department, there is controversy about their utility. This study aimed to determine the usefulness of blood cultures in the management of patients presenting to a tertiary adult teaching hospital emergency department in Perth, Western Australia. ⋯ Blood cultures are ordered on a significant number of patients seen in the emergency department but rarely alter management. Our findings in conjunction with other studies suggest that eliminating blood cultures in immunocompetent patients with common illnesses such as urinary tract infection, community acquired pneumonia and cellulitis, may significantly reduce the number of blood cultures, producing substantial savings without jeopardizing patient care. This needs prospective study and validation.