Emergency medicine journal : EMJ
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To determine the value of abdominal radiography (AXR) for investigating patients attending hospital with a first episode of appendicitis (requiring appendicectomy), acute gallbladder disease or acute pancreatitis, and to identify if early (within 18 h) ultrasound or CT scanning reduces the use of AXR. Setting Two acute teaching hospitals during August-September 2008 and February-March 2009. ⋯ AXR does not aid diagnosis of these conditions but is still performed. Early ultrasound or CT scanning reduces the use of AXR and are more sensitive; methods of providing these should be explored.
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A 62-year-old man presented 6 h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. ⋯ Over the following 24 h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures.
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The purpose of this study was to investigate barriers to surge capacity of an overcrowded emergency department (ED) for a foodborne disease outbreak (FBDO) and to identify solutions to the problems. ⋯ Patients with FBDO could arrive at the hospital shortly after exposure without field triage and management. The incident command system and emergency operation plan of the study hospital did not address the clinical characteristics of the FBDO and the problem of ED overcrowding. Further planning and training of foodborne disease and surge capacity would be beneficial for hospital preparedness for an FBDO.
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This paper describes a 21-year-old man who presented to the emergency department with a knife wound to his buttock. He had a witnessed cardiac arrest with pulseless electrical activity in hospital as a result of further haemorrhage. His post-resuscitation arterial blood gas revealed a severe lactic acidosis (pH 6.61, lactate 22.0 mmol/l). ⋯ Severe lactic acidosis occurs post cardiac arrest due to imbalance between cellular oxygen supply and demand. Severe lactic acidosis is associated with hypoxic brain injury but has a low specificity in its prediction. The case illustrates that, especially in younger adults, severe lactic acidosis may be a poor predictor of outcome if it reflects a period of relative hypoperfusion preceding cardiac arrest.