Emergency medicine journal : EMJ
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Many patients present late after a transient ischaemic attack (TIA). This delays intervention and may partly depend on where patients first present--emergency department (ED) or general practitioner (GP). Studying this behaviour could improve stroke prevention through better targeting of public education and allocation of resources. ⋯ Most patients presenting to an ED go urgently, whereas most going to a GP delay, particularly at weekends. Most Canadian patients, particularly those at high risk, go to an ED whereas most UK patients go to a GP. One way to reduce delay, particularly in the UK, would be to direct all patients with TIA to go to an ED rather than to their GP.
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Case Reports
Non-infectious subcutaneous emphysema of the hand: a case report and review of the literature.
Subcutaneous emphysema in the hand can result from infectious and non-infectious aetiologies. Adequate history, physical examination, laboratory studies and imaging are needed to delineate the cause, to prevent debilitating consequences and to avoid unnecessary procedures and interventions. ⋯ A literature review of cases of non-infectious subcutaneous emphysema is presented here with an overview of the mechanism of injury, as well as the course and management. Certain criteria are also outlined to help differentiate between infectious and non-infectious emphysema, which include laboratory studies, imaging, timing and clinical symptoms.
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The case history is presented of a healthy 25-year-old man who was admitted to hospital after two syncopal episodes caused by carbon monoxide poisoning after smoking narghile. Clinicians should be aware of this association when they evaluate syncope in the emergency department, especially in narghile users.
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The epidemiology of aortic transection is changing with improvements in road safety and the use of endovascular stents. This research investigates the profile of cases and outcomes of traumatic thoracic aortic transection in Victoria, Australia. ⋯ Aortic transection was generally secondary to traffic-related injury affecting young men, with a mortality rate of over 90%. There has been a trend towards endovascular treatment over open repair in Victorian trauma centres.