European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this study was to elucidate the clinical presentation of ectopic pregnancy in the emergency department and highlight the atypical presentations and pitfalls in its diagnosis. This was a 4-year retrospective descriptive study carried out at a tertiary teaching hospital. Two hundred and seven cases of ectopic pregnancy treated in a tertiary teaching hospital were reviewed. ⋯ Any female in the reproductive age group with syncope, abdominal symptoms or any of the components of the classical triad must have ectopic pregnancy excluded. Patients with normal ultrasound studies should have their serum beta HCG levels and ultrasound scans repeated until the condition can be completely excluded. Transabdominal or transvaginal ultrasound studies done within the emergency department would enable earlier diagnosis and management.
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The earliest possible initiation of reperfusion therapy is necessary to prevent extended necrosis, preserve ventricular function, and reduce morbidity and mortality from acute myocardial infarction. Therefore, improving the time to thrombolysis is a critical goal of patient management. Four complementary strategies have been employed in an attempt to shorten the time to thrombolytic therapy: (1) public education to shorten the delay in summoning help, (2) prehospital thrombolysis by trained emergency-response personnel, (3) implementation of emergency department thrombolysis protocols, (4) and the use of rapid diagnostic techniques to confirm acute myocardial infarction. ⋯ Therefore, new thrombolytic agents have been bioengineered with characteristics that make them better suited for use in this setting. Two of these agents, TNK-t-PA and nPA, have extended half-life profiles that permit single-bolus dosing--an important consideration when fibrinolytic therapy is initiated outside the coronary care unit. The most effective system will integrate these complementary strategies to deliver continuous patient care from the time of the call for help, through emergency response, transportation, hospital admission, assessment, and initiation of thrombolytic therapy.
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The objective of this study was to describe early circulatory events of patients presenting to the emergency department (ED) with severe sepsis or septic shock. Invasive and noninvasive monitoring were used to evaluate sequential patterns of both central haemodynamics and peripheral tissue perfusion/oxygenation and to test the hypothesis that increased cardiac output is an early compensation to increased body metabolism. This is a prospective observational study of 45 patients who entered the ED with severe sepsis or septic shock in an urban academic ED. ⋯ It is concluded that ED monitoring septic patients provides a unique opportunity to document early physiologic interactions between cardiac, pulmonary, and tissue perfusion functions in surviving and nonsurviving patients with septic shock. The data is consistent with the concept that increased cardiac output is an early compensatory response to increased body metabolism. Real time haemodynamic monitoring of patients in the ED provides early warning of outcome and may be used to guide therapy.
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The aim of this study was to describe the characteristics and long-term outcome for patients suffering from acute chest pain in relation to whether or not they were transported to hospital by ambulance. All patients with acute chest pain who were admitted over a 21-month period to the emergency department at Sahlgrenska Hospital in Göteborg with symptoms of acute chest pain were included in the study. Consecutive patients were prospectively registered and followed with regard to mortality and morbidity over 5 years. ⋯ It is concluded that among patients admitted to the emergency department with acute chest pain, those transported by ambulance had a much higher mortality during the subsequent 5 years than those who were not transported by ambulance. This was not entirely explained by observed differences at baseline. This information should be considered when ambulance organizations are being constructed.
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Spontaneous pneumomediastinum is a rare condition and a most uncommon complication of sporting activity. We describe a case of spontaneous pneumomediastinum in a 17-year-old boy while playing football with no history of blunt trauma to the chest. The patient presented with symptoms and signs suggestive of an oesophageal perforation. The importance of correct investigations and subsequent management are discussed.