Occult traumatic loculated tension pneumothorax--a sonographic diagnostic dilemma.

This case outlines a rarely seen disease in prehospital emergency care-namely, a traumatic loculated tension pneumothorax. Prehospital thoracic ultrasound as part of a standard extended focused assessment with sonography in trauma (EFAST) algorithm failed to diagnose this life-threatening injury. We have subsequently added scanning the lateral chest wall in the fifth intercostal space to the algorithm.

Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales.

OBJECTIVE: To address frequently asked questions regarding the use of the Guardianship Act, the Mental Health Act and the Public Health Act within New South Wales EDs and present an algorithm to guide the use of this legislation. METHODS: An ED-specific algorithm was developed for the use of the three pieces of legislation. Then an emergency psychiatrist and an emergency physician reviewed the algorithm with ED staff to understand its usefulness and where further detail was required. Frequently asked questions were collated. RESULTS: Frequently asked questions are addressed with reference to the algorithm. CONCLUSION: This paper offers an algorithm that can be easily followed for use in EDs across New South Wales.

De-labelling self-reported penicillin allergy within the emergency department through the use of skin tests and oral drug provocation testing.

OBJECTIVE: Self-reported penicillin allergy is common among patients attending the ED, but is a poor predictor of true immunoglobulin E-mediated hypersensitivity to penicillin. We hypothesise that with a combination of skin testing and drug provocation testing, selected patients can be safely de-labelled of their allergy. METHODS: This prospective study enrolled a sample of patients presenting to an urban academic ED between 2011 and 2016 with a self-reported allergy to penicillin. Standardised skin prick and intradermal testing with amoxicillin and both major and minor determinants of penicillin was performed in the department. If negative, testing was followed by a graded oral challenge of amoxicillin over 9 days. The primary end point was the allergy status of participants at the end of the study. RESULTS: A total of 100 patients (mean age 42; standard deviation 14 years; 54% women) completed the testing. Of these, 81% (95% confidence interval 71.9-88.2) showed no hypersensitivity to penicillin and were labelled non-allergic. The majority (16/19) of allergies were confirmed by skin testing, with three suspected allergies detected by the oral challenge. Women were more likely than men to have a true penicillin allergy, with odds ratio of 4.0 (95% confidence interval 1.23-13.2). There were no serious adverse events. CONCLUSION: Selected patients in the ED who self-report an allergy to penicillin can be safely tested there for penicillin allergy, using skin tests and oral drug provocation testing. This testing allows a significant de-labelling of penicillin allergy, with the majority of these patients able to tolerate penicillin without incident.

Emergencias y urgencias convulsivas en adultos: diagnóstico y terapéutica agudos basados en evidencia / Emergencies and convulsive urgencies in adults: acute diagnosis and therapeutic based on evidence

El propósito de esta búsqueda y anßlisis bibliogrßfico es revisar el manejo de las convulsiones y del status epiléptico como una situación de emergencia, basado en la evidencia médica disponible, con especial énfasis en sus tiempos y formas. Se han dise±ado tablas y algoritmos para identificar y considerar los principales aspectos del uso racional y eficaz de las medidas diagnósticas y terapéuticas