Impact of senior clinical review on patient disposition from the emergency department.

Introduction: The delivery of high quality emergency medicine ideally involves input from senior doctors 24 h a day. This study aims to assess the influence of 'real-time' senior clinician supervision on patient disposition from a UK emergency department.

Methods: The study was set in a UK teaching hospital with 24 h senior cover.

Reduced productivity among junior trainees in the emergency department and the impact on senior clinicians.

Unlabelled: Emergency medicine has recently undergone significant changes, with training, staffing and service delivery attracting particular attention. Senior doctors are under increased pressure to ensure the prompt delivery of service and to provide a smooth patient journey. It has been suggested that junior trainees see fewer patients than their predecessors, resulting in the burden of clinical work being transferred to senior clinicians, representing a shift away from the traditional model of service delivery.

Severe hypoglycaemia in citalopram overdose.

We present two episodes of poisoning with citalopram in which the main feature was profound hypoglycaemia. Citalopram has been regarded as the most toxic of the selective serotonin reuptake inhibitors in overdose; however, hypoglycaemia is not one of the documented features of overdose. This is an important component of the toxicological profile of citalopram and a treatable cause of seizure activity that should be reported in poisoning information references.