Emergency medicine journal : EMJ
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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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Case Reports
Posterior cranial fossa venous extradural haematoma: an uncommon form of intracranial injury.
Extradural haematomas are commonly associated with direct trauma to the temporal bones of the cranium resulting in damage to the middle meningeal artery or its branches. A case is presented of an occipital skull fracture with venous sinus bleeding that resulted in a posterior cranial fossa extradural haematoma. Bleeding in this area, if unrecognised, may lead rapidly to respiratory arrest secondary to brainstem compression. The presence of significant trauma to the occiput should alert the attending clinician to the possibility of this uncommon but potentially fatal condition.
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It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). ⋯ There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials.