Emergency medicine journal : EMJ
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We identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved. ⋯ Providing a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs.
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Following a spate of high profile murders there is concern that injuries and deaths caused by knives is increasing in England and Wales, especially within the teenage population. Excluding police and Home Office statistics, there are few UK studies examining Emergency Department data. ⋯ Both from TARN and ONS data, the rate of death and serious injury from stab wounds rose in the middle of the last decade but since 2006 is falling. Stabbings account for a low proportion of overall injury deaths and hospitalised trauma patients. The vast majority are due to assault and affect young men in urban areas, particularly London, the North East and the North West. Accidental death from stabbing is rare although suicide using sharp implements, particularly amongst older men, is perhaps more common than previously thought.
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Previous studies suggest intravenous or nebulised magnesium sulphate may improve respiratory function in patients with acute asthma. We aimed to determine whether intravenous or nebulised MgSO4 improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma. ⋯ These data suggest nebulised MgSO4 has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO4 in the ED.
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Traumatic brain injury (TBI) is a leading cause of death and disability in young adults. Reorganisation of trauma services with direct triage of suspected head injury patients to trauma centres may improve outcomes following TBI. This study aimed to determine the sensitivity of principal English triage tools for identifying significant TBI. ⋯ considerable proportion of significant head injury patients may not to be triaged directly to trauma centres. Investment is therefore necessary to improve the accuracy of existing triage rules and maintain expertise in TBI diagnosis and management in non-specialist emergency departments.