Emergency medicine journal : EMJ
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To estimate the potential of general practice, minor injury units, walk in centres and NHS Direct to reduce non-urgent demands on accident and emergency (A&E) departments taking into account the patient's reasons for attending A&E. ⋯ The increasing availability of alternative services offering first contact care for non-urgent health problems, is likely to have little impact on the demand for A&E services.
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Multicenter Study
Pre-hospital aspirin for suspected myocardial infarction and acute coronary syndromes: a headache for paramedics?
To ascertain the frequency with which paramedics follow protocols for the administration of aspirin to patients to whom an ambulance is called for chest pain associated with suspected ischaemic heart disease. ⋯ Aspirin has been shown to be beneficial after a myocardial infarction and for other acute coronary syndromes. However, variances in the proportion of patients with suspected ischaemic heart disease given aspirin in different ambulance services indicates the need for a re-emphasis on the importance of this treatment. A standard protocol for all UK ambulance services should be devised that minimises the number of contraindications to aspirin and otherwise requires its administration to all patients with acute coronary syndromes or suspected myocardial infarction. Regular, standardised audits of compliance should also be conducted and their results widely disseminated.
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Isolated first rib fractures are uncommon. They are usually associated with severe blunt trauma, although other mechanisms have been suggested, these being (a) indirect trauma, (b) sudden contraction of the neck muscles, and (c) stress or fatigue fractures attributable to repeated pull of muscles. Two cases are reported of stress fracture of the first rib, who presented to the accident and emergency department.
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A 66 year old woman presented to the accident and emergency department with history of collapse, hoarseness of the voice, and swelling and bruising of the neck. The diagnosis was not initially obvious because of the absence of chest pain. ⋯ This confirmed the cervical haematoma and typical signs of aortic dissection. This unusual presentation of thoracic aortic dissection is discussed below.