Emergency medicine journal : EMJ
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Emergency medicine in The Netherlands is faced with an increasing interest by politicians and stakeholders in health care. This is due to crowding, increasing costs, criticism of the quality of emergency care, restructuring of out-of-hours services in primary care and the introduction of a training programme for emergency physicians in 2000. A comprehensive search was conducted of published research, policy reports and updated Dutch websites on acute care. ⋯ Although this seems an important step, it does not necessarily imply a good position of the emergency physician in the ED. What the characteristics of the future patient of the Dutch ED will be is dependent on the development of different ED levels of care and GP cooperatives. The lack of empirical research also points out the need for research on quality of care in Dutch ED.
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Comparative Study
Comparison of two clinical scoring systems in risk stratification of non-ST elevation acute coronary syndrome patients in predicting 30-day outcomes.
Non-ST elevation acute coronary syndromes (NSTEACS) confer a broad range of risk of adverse outcomes following presentation to an emergency department. This study compares the Thrombolysis in Myocardial Infarction (TIMI) risk scoring system with the used but untested, Cheshire, Merseyside and North Wales Cardiac Network (CMNW) NSTEACS risk stratification system in predicting the adverse outcomes of re-admission to hospital with either a NSTEACS or death at 30 days post presentation. ⋯ The CMNW score categorised more patients as higher risk, who suffered death at 30 days than the TIMI score.
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The authors report a case of a previously healthy 40-year-old man who was admitted to the emergency department due to severe hypoxaemia after emesis. He vomited after a cup of coffee with the milk at his office. On admission, he showed cyanosis and oxygen saturation measured by pulse oximetry was extremely low (86%) in spite of the administration of 10 litres of oxygen. ⋯ The patient was treated by antibiotics for pneumonia, and his methaemoglobinaemia was spontaneously ameliorated. The authors later found that the patient drank bleach containing hypochlorous acid instead of milk by mistake. To conclude, the patient's hypoxaemia was due to pneumonia and drug-induced acquired methaemoglobinaemia.
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A principal reason to order a head CT scan for dizziness patients is to exclude stroke. As CT imaging is substantially limited in assessing for any acute lesions other than haemorrhage, the most important stroke syndrome adequately evaluated by CT is intracerebral haemorrhage (ICH). A population based stroke database was used to assess the frequency with which ICH might mimic a benign dizziness presentation. ⋯ This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed.