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  1. Nasarudin NM, Mohd Saiboon I, Ismail AK
    Eur J Emerg Med, 2013 Oct;20(5):335-8.
    PMID: 22976462 DOI: 10.1097/MEJ.0b013e328358fa40
    Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
  2. Ismail AK, Mohd Salleh NI, Hamdan NA, Mohd Jawi MI, Abdul Razak SN, Md Jamal S, et al.
    Eur J Emerg Med, 2012 Dec;19(6):408-9.
    PMID: 22343753 DOI: 10.1097/MEJ.0b013e328351e62e
  3. Rahman NH, DeSilva T
    Eur J Emerg Med, 2012 Aug;19(4):241-5.
    PMID: 21968714 DOI: 10.1097/MEJ.0b013e32834bfc17
    Pain seems to be one of the most frequent complaints in the emergency department, however pain control is often suboptimal as seen by many audits. We conducted a study to find out whether the use of patient control analgesia (PCA) is effective in controlling acute pain in the emergency department
  4. Bewersdorf JP, Hautmann O, Kofink D, Abdul Khalil A, Zainal Abidin I, Loch A
    Eur J Emerg Med, 2017 Jun;24(3):170-175.
    PMID: 26524675 DOI: 10.1097/MEJ.0000000000000344
    OBJECTIVES: The aim of the study was to identify covariates associated with 28-day mortality in septic patients admitted to the emergency department and derive and validate a score that stratifies mortality risk utilizing parameters that are readily available.

    METHODS: Patients with an admission diagnosis of suspected or confirmed infection and fulfilling at least two criteria for severe inflammatory response syndrome were included in this study. Patients' characteristics, vital signs, and laboratory values were used to identify prognostic factors for mortality. A scoring system was derived and validated. The primary outcome was the 28-day mortality rate.

    RESULTS: A total of 440 patients were included in the study. The 28-day hospital mortality rate was 32.4 and 25.2% for the derivation (293 patients) and validation (147 patients) sets, respectively. Factors associated with a higher mortality were immune-suppressed state (odds ratio 4.7; 95% confidence interval 2.0-11.4), systolic blood pressure on arrival less than 90 mmHg (3.8; 1.7-8.3), body temperature less than 36.0°C (4.1; 1.3-12.9), oxygen saturation less than 90% (2.3; 1.1-4.8), hematocrit less than 0.38 (3.1; 1.6-5.9), blood pH less than 7.35 (2.0; 1.04-3.9), lactate level more than 2.4 mmol/l (2.27; 1.2-4.2), and pneumonia as the source of infection (2.7; 1.5-5.0). The area under the receiver operating characteristic curve was 0.81 (0.75-0.86) in the derivation and 0.81 (0.73-0.90) in the validation set. The SPEED (sepsis patient evaluation in the emergency department) score performed better (P=0.02) than the Mortality in Emergency Department Sepsis score when applied to the complete study population with an area under the curve of 0.81 (0.76-0.85) as compared with 0.74 (0.70-0.79).

    CONCLUSION: The SPEED score predicts 28-day mortality in septic patients. It is simple and its predictive value is comparable to that of other scoring systems.

  5. Moissinac K, Ponnampalam J, Chong Se To B
    Eur J Emerg Med, 2000 Dec;7(4):297-9.
    PMID: 11764140
    Although bleeding into the intestinal lumen may occur in strangulating intestinal obstruction, haematemesis is infrequently encountered. We report on a patient who presented with haematemesis and who had, in addition, clinical and radiological features of small bowel obstruction. Upper gastrointestinal endoscopy did not locate the source of bleeding. At laparotomy, which was performed because of clinical deterioration, gangrenous strangulated small bowel secondary to adhesive obstruction was found. In a patient with non-resolving intestinal obstruction, a deterioration in the condition is a clear indication for exploration. Haematemesis occurring concurrently may be a marker of intestinal strangulation, adds strength to the indication and highlights the urgency of the need for exploration.
  6. Osman A, Wan Chuan T, Ab Rahman J, Via G, Tavazzi G
    Eur J Emerg Med, 2018 Oct;25(5):322-327.
    PMID: 28509710 DOI: 10.1097/MEJ.0000000000000471
    OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.

    BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.

    METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.

    CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.

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