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How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments

Emergency Medicine Journal

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

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How Not To Miss Posterior Circulation Stroke

ACEP Now

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. His neurological exam on arrival is documented as normal. His blood pressure is 190 over 115.

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Sickle Cell Disease Module

Don't Forget the Bubbles

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. How is sickle cell disease diagnosed?

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The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults

RebelEM

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist.

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An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

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How To Avoid Missing an Aortic Dissection

ACEP Now

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. 1 Opioids or anxiolytics are often given to patients whose diagnosis of AD is missed or delayed.

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emDOCs Podcast – Episode 86 Tricky Cases Part 2

EMDocs

Also think about NCSE in patients with prior cerebral pathology (ie, ischemic stroke); a patient who was seizing, was treated, and is not coming out of their post ictal state; and in patients with unexplained altered mental status with no other cause. Official diagnosis requires EEG, which is not something we can typically obtain in the ED.