Objective: The Quebec shoulder dislocation rule is a recently derived clinical decision rule to guide physicians on the selective use of radiography in patients with shoulder dislocation. The aim of this study was to validate the Quebec shoulder dislocation rule. Methods: This was a secondary analysis of data collected in a retrospective cohort study. All patients presenting to the emergency department (ED) between January 1, 2003, and October 31, 2008, with a diagnosis of shoulder dislocation or fracture-dislocation were identified from ED management databases. Data collected included demographics, mechanism of injury, and presence of fracture. The outcome of interest was predictive performance of the Quebec shoulder dislocation rule for patients aged under 40 years on this cohort. Data analysis is descriptive. Results: Of the 346 patients identified, 196 were aged under 40 years, and 174 (89%) were male; the median age was 25 years (interquartile range 21-29 years), and 58 were recurrent dislocations. One hundred sixteen patients (59%) met the Quebec high-risk criteria, and 80 (41%) were classified as low risk. In the 196 patients aged less than 40 years, 12 fractures as defined were identified (6%). When applied to this cohort, the Quebec clinical decision rule had a sensitivity of 0.42 (95% CI 0.16-0.71), a specificity of 0.40 (95% CI 0.33-0.47), and a negative predictive value of 0.91 (95% CI 0.82-0.96). Conclusion: The Quebec shoulder dislocation rule had poor sensitivity for clinically significant fractures associated with shoulder dislocations in young patients (aged 16-39 years) presenting to an Australian emergency department. Its use cannot be recommended. RÉ SUMÉObjectif : La rè gle de dislocation de l'é paule en vigueur au Qué bec est une rè gle de dé cision clinique ré cemment adopté e pour guider les mé decins quant à l'utilisation sé lective de la radiographie chez les patients ayant subi une dislocation de l'é paule. Le but de cette é tude é tait de valider la rè gle de dislocation de l'é paule en vigueur au Qué bec. Conclusion : La rè gle de dislocation de l'é paule en vigueur au Qué bec avait une faible sensibilité sur le plan clinique pour les fractures importantes associé es aux dislocations de l'é paule chez les jeunes patients (de 16 à 39 ans) qui se sont pré senté s aux urgences en Australie. Son utilisation ne peut pas ê tre recommandé e.

Two cases of toxicity from industrial exposure to hydrogen sulfide are presented. Both patients had neurological effects with loss of consciousness and amnesia along with respiratory symptoms and signs. Both were treated with hyperbaric oxygen therapy in addition to standard resuscitative techniques with rapid improvement. Sodium nitrite and hyperbaric oxygen therapy are suggested specific treatments. The literature and the two case reports support the use of hyperbaric oxygen therapy in the treatment of acute hydrogen sulfide toxicity. Hyperbaric oxygen therapy has also been reported to have a role in the prevention of both short‐ and long‐term neurological toxicity.

The objective of the Primary Examination is to ensure that trainees have the required level of knowledge and understanding of the four basic sciences of anatomy, pathology, physiology and pharmacology to underpin their further learning and development towards careers as emergency medicine physicians. The candidate is expected to show an understanding of the subject matter and demonstrate their ability to apply their knowledge to the practice of emergency medicine. As part of the curriculum review, ACEM undertook to implement changes to the Primary Examination in order to make it more clinically relevant.

Phenothiazines are more effective than placebo for the treatment of migraine headache and have higher rates of clinical success than other agents against which they have been compared.

No abstract