Emergency medicine journal : EMJ
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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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Early goal-directed therapy (EGDT) has been shown to improve outcome in patients presenting to the emergency department (ED). Uptake of EGDT in EDs in the UK has been slow. ⋯ Full delivery of EGDT by ED staff would require significant consultant support, improved training of juniors and flexibility in the 4 h target. This study suggests that it may be practical for EGDT to be initiated in the ED and that early referral to critical care will remain essential if patients are to receive the full benefit of this intervention.
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Traditionally, blunt traumatic aortic rupture (BTAR) is thought to be a high-velocity injury. It was hypothesised that BTAR has a higher than suspected incidence in low-speed accidents, with unique kinematic and demographic risk factors. ⋯ Low-impact collisions account for two thirds of fatal aortic injuries. Age >60, lateral impacts and struck side seat position are predictive of LIBTAR. Low-impact cases were associated with minor (potentially subclinical) intimomedial injuries. Therefore, it is recommended that a higher index of suspicion of aortic injury is used in low-impact scenarios in the risk groups identified.
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To explore the nature of interruptions that occur during clinical practice in the emergency department (ED). We determined the frequency, duration and type of interruptions that occurred. We then determined the impact on patient satisfaction of those interruptions occurring at the bedside. ⋯ Interruptions occur commonly during all clinical activities in the ED, and are frequently generated by providers themselves. These have a negative impact on patient satisfaction. The direct impact on medical errors or on provider satisfaction has not been determined.