Emergency medicine journal : EMJ
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Computed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma. ⋯ This study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.
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Increasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation. ⋯ Ambulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment. Abstract 031 Figure 1Periorbital Cellulitis. Abstract 032 Figure 1Street Doctors.
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Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk-stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.
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Since 'legal highs' emerged as drugs of abuse in the UK, Emergency Physicians have battled to keep up with the latest drug craze. Whilst many of these drugs present with recognisable toxidromes, the effect of new compounds or medications cannot be readily predicted. In Belfast, we have witnessed a recent increase in the number of patients presenting after recreational abuse of Pregabalin (Lyrica). Patients, state that the medication induces a state similar to drunkenness, hence the street name 'Budweiser's'. To our knowledge this is the first case series detailing the recreational abuse of Pregabalin, a drug which has become popular in primary care. ⋯ Emergency Physicians should be aware of the current use of Pregabalin as a recreational drug. Patients are either taking tablets whole or cutting and snorting them. 60% of patients in this case series presented to the ED with seizures and 20% required ICU admission. We recommend that patients who present with potential Lyrica toxicity should be admitted for observation with the treating physician being mindful of the potential for seizure activity.
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Redbridge Tackling Knife Crime Programme was an initiative run between Redbridge Safer Communities Partnership, a London-based police force and Barking, Havering and Redbridge University Hospital Trust. It comprised of data collection resulting in the analysis of types of assault, locations, demographics of both assailant and victim and were police informed. Domestic violence (DV) was identified as a category of assault. The inspiration came from the 1996 'Cardiff-model'-the Violence Prevention Group shared ED assault data with its police force. The outcome led to enhanced effectiveness of the police in managing alcohol-related violence. The TKAP aim is it identify DV locations and patterns, otherwise unknown to police by improved intelligence gathered through ED data. As a result police deployment can reflect areas of need and allow police to compare their own figures allowing a more informed service for DV victims. ⋯ will be used to implement police enforcement activities and prevention work, hence improving safe-guarding.