Emergency medicine journal : EMJ
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A short cut review was carried out to establish cricoid pressure reduced aspiration during rapid sequence induction (RSI) of anaesthesia. A total of 241 papers were identified using the reported search, of which three represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. There is little evidence to support the widely held belief that the application of cricoid pressure reduces the incidence of aspiration during a rapid sequence intubation.
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All medical practitioners working within the NHS are subject to annual appraisal and in the future revalidation. Medical responders acting on behalf of NHS Ambulances Trusts often working in a voluntary capacity will require appraisal either individually (those working exclusively in prehospital care) or jointly (for hospital practitioners or GP's who are also involved prehospital care). They will be required to demonstrate satisfactorily adherence to the principles of clinical governance and develop a CPD portfolio. ⋯ To establish a mutual understanding between the Ambulance Services and medical practitioners the Faculty of Prehospital Care has met with stakeholders to establish a code of practice which has been agreed and endorsed by the Ambulance Service Association. This document clearly defines both individual and joint responsibilities to establish good practice. For many practitioners much of what is contained in this document will already be in place.
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A short cut review was carried out to establish the best way to immobilise dislocated shoulders after reduction. A total of 47 papers were identified using the reported search, of which four represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. For patients with a first anterior shoulder dislocation immobilisation in external rotation may be of more benefit than immobilisation in internal rotation.
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Review
When should we thrombolyse patients with pulmonary embolism? A systematic review of the literature.
The early mortality in pulmonary embolism (PE) is largely predicted by the associated cardiovascular response, with progressive right ventricular failure, hypotension, shock, and circulatory arrest being associated with increasing mortality. Thrombolysis may improve the prognosis of PE associated with these varying degrees of circulatory collapse, but has no place in the treatment of small emboli with no cardiovascular compromise, as it carries a significant risk of haemorrhage. This review sets out to guide the emergency physician in deciding which patients with PE may benefit from thrombolysis.
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In any accident scene, rapid removal of the casualty to hospital improves their chances of survival. The term the "Golden Hour" was first introduced in 1961, but because of misinterpretation as to what period this actually referred to, a second concept, the "Platinum Ten Minutes" was proposed as the time taken to move a casualty to the ambulance. ⋯ This paper describes the role of the emergency services, in particular that of the fire officer in charge, when attending the scene of a road traffic accident. The methods and equipment used to extricate a casualty from a motor vehicle are explained.