Emergency medicine journal : EMJ
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There is no specific antidote for the treatment of casualties exposed to chlorine, phosgene, or mustards; therefore, management is largely supportive. Corticosteroid treatment has been given to casualties accidentally exposed to chlorine. Clinical data on efficacy are inconclusive as the numbers given steroids have been small and the indications for administration unclear. ⋯ Lung injury induced by phosgene and mustard appears to be mediated by glutathione depletion, lipid peroxidation, free radical generation, and subsequent cellular toxicity. There is limited evidence to suggest that repletion of glutathione reduces and/or prevents lung damage by these agents. This may provide an opportunity for therapeutic intervention.
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A significant number of emergency department (ED) patients in Japan may be affected by mental health problems leading to attempted suicide. This retrospective descriptive study aimed to explore mental health service needs in a Japanese medical centre ED. ⋯ Approximately 38% (95% CI 35.8 to 39.9) of patients presenting to an ED could be affected by mental health problems.
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Vibrio vulnificus is a Gram-negative marine bacterium that may cause local wound infection, gastroenteritis, or septicaemia. Fatal septicaemia usually presents with fever, shock, and large haemorrhagic bullae on the legs. This report is about a man who had severe V. vulnificus septicaemia but presented with atypical features of leg pain and diffuse purpuric skin lesions. V. vulnificus septicaemia should be suspected if the following are present: septic shock, leg pains associated with diffuse purpuric skin lesions, recent consumption of raw seafood, and a past medical history of liver cirrhosis.
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A 2-year-old boy presented to the emergency department with a history of sudden onset of cough, dyspnoea and a slight expiratory wheeze on the right lung base. He also had subcutaneous emphysema on the left side of the chest anteriorly. Chest x ray confirmed subcutaneous emphysema and also revealed pneumomediastinum and pneumopericardium. ⋯ He was successfully treated with nebulised salbutamol, steroids, antibiotics and high flow oxygen. He made a good recovery and was discharged after 7 days. This case highlights the need for a high index of suspicion of asthma in very young children presenting for the first time with such complications.