Emergency medicine journal : EMJ
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Comparative Study
Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy.
To examine the suitability of commonly available ballpoint pens as a substitute emergency tracheostomy tube. ⋯ Contrary to popular belief, the majority of ballpoint pens appear unsuitable for use as a substitute tracheostomy tube. In this study only two pens fulfilled the criteria for use: the Baron retractable ballpoint and the BIC soft feel Jumbo.
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NICE guidelines provide clear indications for the investigation of head injuries with CT. A patient on anticoagulation is required to have lost consciousness to warrant a CT scan unless obvious stronger indications exist. We recently observed three patients who had been assessed following head injuries that did not fulfil the NICE criteria for a CT scan, but who subsequently were found to have significant brain injury, all of whom were on warfarin. This experience prompted us to categorise whether the CT scans for head injuries performed were done so with indications consistent with the NICE guidelines, and then examine the outcomes to determine the effectiveness of the NICE guidelines for picking up positive pathology. ⋯ While NICE guidelines provide a valuable tool for the investigation of head injuries, we feel that elderly patients on anticoagulation may be at risk of having significant head injuries missed and a lower threshold for scanning should be adopted.
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To primarily assess the value of troponin I to identify acute myocardial infarction (AMI), and second, to predict 1-month serious outcome or all-cause death in patients presenting with syncope to the Emergency Department (ED). ⋯ AMI is infrequent (1.4%), and estimation of troponin I provides little additional benefit to the presenting ED ECG in identifying patients with syncope due to AMI. Troponin I should not be used to rule out AMI in adult patients presenting with isolated syncope. Troponin I may predict 1-month serious outcome or all-cause death in syncope.
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Paroxysmal supraventricular tachycardia (SVT) is a relatively common problem presented to the emergency department. Most sources advocate the use of vagal manoeuvres as first-line management, including Valsalva manoeuvre. Despite this, there is lack of standardisation as to how the technique is performed. There is currently no 'gold standard' Valsalva manoeuvre. We propose a modified Valsalva manoeuvre, based on techniques described in small-scale electrophysiological studies, but no large clinical trials. ⋯ Our findings support previous observations that there is lack of standardisation as to how Valsalva is performed, and an apparent reliance on adenosine. The impact of introducing this technique as our departmental standard was a raise in non-pharmacological reversion from 5.3% to 31.7% with no reported significant adverse effects.
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This study describes patients admitted to an urban emergency service in France during the 2003 heat wave. Patients with heat-related illnesses were studied and comparison was made between those who died and survivors. ⋯ Heat-related illnesses are a group of underestimated and underdiagnosed conditions with high morbidity and mortality rates.