Abdominal pain and collapse in the emergency department.

Rupture of a splenic artery aneurysm is a rare but life-threatening presentation to the emergency department. This case demonstrates the importance of swift resuscitation and the benefit of bedside imaging in a highly unstable patient. The definitive management of this condition in patients who are refractory to resuscitative attempts is immediate surgery with the diagnosis often only confirmed at laparotomy.

Morbidity in adults with a normal limited scaphoid MRI: a retrospective cohort study and follow-up questionnaire.

Introduction: The scaphoid bone is the most commonly fractured carpal bone. MRI is now recognised to be more sensitive and specific than serial plain films in the diagnosis of occult scaphoid fracture. What is not known is whether it is safe to discharge, without follow-up, those with a normal limited extremity MRI.

Carotid sinus massage: is it a safe way to terminate supraventricular tachycardia?

A 63-year-old women with a history of palpitations presented to the emergency department with a supraventricular tachycardia; the patient was cardiovascularly stable. Carotid sinus massage (CSM) was performed to help identify the underlying rhythm. During massage the patient had an immediate cerebrovascular accident, resulting in a left hemiplegia.

Tension pneumothorax secondary to automatic mechanical compression decompression device.

The details are presented of the first published case of a tension pneumothorax induced by an automatic compression-decompression (ACD) device during cardiac arrest. An elderly patient collapsed with back pain and, on arrival of the crew, was in pulseless electrical activity (PEA) arrest. He was promptly intubated and correct placement of the endotracheal tube was confirmed by noting equal air entry bilaterally and the ACD device applied.

Emergency department board rounds: are they worthwhile?

Objective: To determine whether daily board rounds in the emergency department (ED) alter patient management and whether they provide educational opportunities.

Method: A prospective observational study of board rounds conducted in a small to medium-sized ED in the United Kingdom. Data were collected on changes made and educational events that took place.

Airway management in patients with a broadcomplex tachycardia requiring electrical cardioversion: a postal survey.

This study was to determine whether or not ED and ICU consultants would intubate an unstarved, haemodynamically unstable patient with a BCT requiring electrical cardioversion, and to determine the incidence of complications for both intubating and not intubating based on the responders personal experience. 174 postal questionnaires were sent to ED and ICU consultants in the Wessex and South West regions of England. They were asked whether or not they would intubate a patient that required electrical cardioversion for a BCT with hypotension.

Reduction of dislocated hip prosthesis in the emergency department using conscious sedation: a prospective study.

This prospective observational study aimed to determine the rate of success of reduction of dislocated hip prostheses using conscious sedation. In 101 consecutive patients presenting to the emergency department between August 2000 and February 2003 with a dislocated hip prosthesis, reduction was attempted using conscious sedation. The outcome measures of the study were (a) rate of success of the attempted reductions (b) rate of complication of the sedation or the procedure, and (c) rate of success in the three subgroups (based on degree of dislocation).

Postpartum maternal moods and infant size predict performance on a national high school entrance examination.

Background: In an earlier series of studies, we documented the effects of feeding practices and postnatal maternal mood on the growth and development of 226 Barbadian children during the first few months of life. In this report, we extend our earlier studies by examining predictive relationships between infant size, feeding practices and postpartum maternal moods and scores on a national high school examination, the Common Entrance Examination (CEE), at 11 to 12 years of age.

Methods: Feeding practices, anthropometry, and maternal moods, using Zung depression and anxiety scales and a morale scale, were assessed at 7 weeks (n = 158), 3 months (n = 168), and 6 months (n = 209) postpartum.

Hyperkalaemic paralysis--a bizarre presentation of renal failure.

Paralysis due to hyperkalaemia is rare and the diagnosis may be overlooked in the first instance. However it is rapidly reversible and so long as electro-cardiography and serum potassium measurement are urgently done in all patients presenting with paralysis, it will not be missed. A case of hyperkalaemic paralysis is described and a review of the emergency management discussed.

Oesophageal perforation: a rare complication of minor blunt trauma.

Oesophageal perforation following blunt trauma is rare and accounts for less than 10% of all oesophageal ruptures. Review of published reports revealed only two cases of isolated oesophageal perforation after minor blunt trauma, and these were as a direct result of the Heimlich manoeuvre. This paper describes a case of perforation of the oesophagus as an isolated injury following blunt minor trauma.