Emergency medicine journal : EMJ
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Tracheal intubation is often difficult in the prehospital setting, especially in trapped casualties, when long extrication time is anticipated and conventional laryngoscopy cannot be achieved. The aim of the present study was the comparison of applicability and efficacy of two alternative techniques: intubation using a laryngeal mask airway (ILMA) or an Airtraq laryngoscope in different patient positions, using an airway management manikin. ⋯ These preliminary data in manikins could indicate the applicability of the methods to the prehospital setting.
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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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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.
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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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The number of annual patient visits to US emergency departments (ED) has been increasing since 1995, whereas the number of ED is decreasing. Previous studies have identified many reasons why patients seek care in ED, including lack of access to care elsewhere, lack of insurance, inability to see their doctor in a timely manner and lower levels of social support. This study identifies factors that influence patients' decisions to seek care in ED and assesses their access to primary care. ⋯ Convenience, location, institutional preference and access to other physicians are common factors that influence patients' decisions to seek care in ED.