CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. ⋯ We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources.
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A 12-year-old girl, who has had a history of intermittent skin rashes since infancy, presents for the sixth time in four months for exacerbation of eczema that is not responding to recommended treatment (daily baths, frequent moisturization and twice-daily application of medium-potency topical corticosteroids). Her parents express concern about the effect of her skin disease on the child's life. They are worried about her sleeping difficulties and decreased involvement in her regular activities; for example, she has stopped playing sports and attending school. ⋯ Skin examination shows generalized xerotic skin and erythematous patches, with predominantly flexural and facial excoriations affecting about half of the body. There is no evidence of burrows, track marks, vesicular or pustular lesions, or honey-coloured crusts. The rest of the exam is unremarkable.