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OBJECTIVES The aim of this study was to describe baseline coagulation in patients presenting to the emergency department (ED) with a ruptured abdominal aortic aneurysm (rAAA) and its effect on survival. METHODS Retrospective study of ED, theatre and laboratory records of patients presenting with rAAA to the Royal Infirmary of Edinburgh ED. Patients with symptomatic aneurysms, those without an initial ED coagulation screen and those on warfarin were excluded. Major coagulopathy was defined as international normalized ratio or activated partial thromboplastin time (APTT) ratio of at least 1.5 or platelet count less than 50 × 10/l. RESULTS Between 1 July 2006 and 31 March 2011, 119 patients were enrolled. Mean (± SD) age was 76.5 ± 7.6 years and male to female ratio was 2.3 : 1. Ten patients died in the ED, 20 were considered not fit for surgery and 89 went to theatre. A total of 56 survived to hospital discharge. Seventeen (14.3%) patients had a major coagulopathy; an international normalized ratio or APTT ratio of at least 1.5. No patients had platelets less than 50 × 10/l, but eight patients had platelets less than 100 × 10/l. Neither ED prothrombin time (PT) nor ED APTT was associated with survival in either the operated [P=0.167 NS (PT) and P=0.353 NS (APTT); two-sided t-test] or entire cohort [P=0.254 NS (PT) and P=0.413 NS (APTT); two-sided t-test] groups. CONCLUSION Although coagulopathy is often present in patients presenting with a rAAA, it does not seem to be associated with a poorer outcome. Our results seem to suggest that altering the current practice of minimal transfusion in the ED to include early transfusion of blood products, such as platelets or fresh frozen plasma, is therefore unlikely to improve outcome.

Objectives and background For the first time in the Emergency Department (ED), to assess the use of rotational thromboelastometry (ROTEM) in patients presenting with all-cause haemodynamic shock, specifically (a) to establish whether a 5- min (A5) or a 10-min result (A10) is accurate compared with a final maximum clot firmness (MCF) result; (b) to compare time to A10 and formal laboratory coagulation result; (c) to assess whether bleeding ED trauma, gastrointestinal and aortic aneurysm patients are coagulopathic according to ROTEM; and (d) to compare ROTEM results with formal laboratory coagulation parameters. Methods Patients presenting to the ED in haemodynamic shock were recruited. A citrated coagulation sample was taken and once a ROTEM researcher arrived in the ED, was subjected to ROTEM analysis. Results Between 28 September 2010 and 31 August 2011, 40 patients were recruited (15 gastrointestinal bleeds, 20 major trauma cases and five ruptured abdominal aortic aneurysms). A10 and MCF correlated well (κ=0.98); A5 and MCF correlated less well (κ=0.91). The mean time to result (SD) was 57 (28) min for the formal laboratory coagulation result and 50 (45) min for the ROTEM A10 result (including delay to start of analysis). Seven patients were coagulopathic on ROTEM. Conclusion Eighteen percent of bleeding ED patients are coagulopathic using ROTEM including 25% of trauma patients. A 10-min ROTEM clot firmness (A10) is an excellent surrogate for MCF and allows a result to be obtained earlier than formal laboratory results and potentially within 10 min of the patient arriving in the ED.

The objective of this study was to assess whether the number of syncope attendances to the Emergency Department is related to daily temperature and humidity, or time of the day, day of the week, month or season of the year. All adult patients presenting with syncope over a 1-year period between 1 March 2007 and 29 February 2008 were enrolled. A circadian pattern of syncope attendances exists, peak attendance was between 10 : 00 and 16 : 00 h, especially in those aged above 65 years (P

Gamma hydroxybutyrate is increasingly being used recreationally in the United Kingdom. We present a case of gamma hydroxybutyrate overdose associated with paroxysmal sympathetic storm, a phenomenon usually confined to patients who have sustained traumatic brain injury.