Emergency medicine journal : EMJ
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A short-cut review of the literature was carried out to establish whether the biological marker procalcitonin could safely rule out the diagnosis of meningococcal disease (MCD) in children. Using the below outlined search method and after the exclusion of the non-relevant papers, two were found to be relevant to the specific question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 3. The clinical bottom line is that the currently available evidence is not sufficient to support the sole use of procalcitonin to rule out the diagnosis of MCD.
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To assess public knowledge of stroke and transient ischaemic attack symptoms, and awareness of the content of a recent national health campaign. ⋯ The survey has confirmed the effectiveness of the recent FAST campaign in raising public awareness of stroke and stroke warning signs, though poorest penetration was seen in the black and minority ethnic population. However, important stroke symptoms, including leg weakness and visual loss, were poorly recognised. This may lead to delays in presentation, specialist assessment and secondary prevention, and such stroke warning signs should be included in future public health campaigns.
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Supracondylar fractures are associated with a high incidence of neurovascular complications. Comprehensive clinical evaluation is a necessity when children with these injuries present to the emergency department. Neurovascular assessment can be difficult due to pain, anxiety and the young age of these patients; however, it is crucial findings are well documented to identify patients requiring urgent surgical intervention, in addition to allowing the neurovascular status to be monitored over time. The aim of this study was to evaluate the preoperative neurovascular documentation in children presenting with displaced supracondylar fractures and devise an emergency department assessment proforma to facilitate comprehensive evaluation. ⋯ Preoperative documentation of neurovascular status in children with displaced supracondylar fractures was poor. Documentation of AIN examination was particularly poor. The introduction of a proforma (Liverpool upper limb fracture assessment) is proposed to increase documentation of neurovascular assessment and optimise emergency department evaluation of children presenting with upper limb injuries.
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This study evaluated the feasibility of prehospital tissue oxygen saturation (StO₂) in major trauma patients. ⋯ Prehospital measurement and monitoring of StO₂ is feasible in trauma patients undergoing prehospital anaesthesia and may be useful in the early identification of shock, triggering of transfusion protocols and guiding fluid resuscitation.
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To explore areas of consensus and disagreement concerning the interhospital transfer of patients with a clinical diagnosis of ruptured abdominal aortic aneurysm. ⋯ There is broad agreement about the type of patient who should be eligible for transfer but disagreements about patient management before and during transfer remain.