Right heart thrombus: the importance of early intervention.

A case report of mobile, right heart thrombus in the accident and emergency (A&E) department is presented. Though frequently associated with major pulmonary embolism, recognition is usually at postmortem examination. Detection of the presence of mobile thrombus in the right heart by early echocardiogram and prompt treatment may be life saving.

Effects on patient care of introducing prehospital intravenous nalbuphine hydrochloride.

Objective: Since March 1992, intravenous nalbuphine hydrochloride has been used prehospital by paramedics in the Plymouth area. This study assesses the impact of this intervention.

Methods: A prospective study of the parenteral analgesic requirements of 1000 consecutive patients arriving by ambulance at the accident and emergency (A&E) department of a large district general hospital.

Double take--fracture fishing in accident and emergency practice.

Objective: To investigate conditions where, after initially negative plain x rays following trauma, there subsequently proves to be fracture, and to explore ways in which the management might be improved.

Design: A 16 month prospective study. Patient details were collected from accident and emergency (A&E) review clinics and returns, A&E ward admissions, correspondence from other services, and discussions at a weekly clinicoradiological conference.

Erythema nodosum--diagnostic difficulties in the accident and emergency department.

Five patients presenting with erythema nodosum to an accident and emergency department are described. Initially they were misdiagnosed as cellulitis, infected insect bites, and minor trauma. Suspicious skin lesions or joint manifestations occurring either alone or especially if in combination should alert the wary clinician to the possibility of erythema nodosum and follow up in a few days may help to confirm the diagnosis.