Emergency medicine journal : EMJ
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The threat of chemical, biological, radiological and nuclear incidents is unlikely to decrease and preparations to deal with this type of incident are well established in most European emergency medical systems. In the UK medical care is not currently provided in the "Hot" or contaminated zone. This article discusses the background to the current threat and suggests that, where survivors are present in the "Hot Zone", medical care should be started there to minimise delay and maximise the chances of survival.
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To assess changes in basic ophthalmic training of accident and emergency (A&E) senior house officers (SHOs) in the last 10 years, their own perceived level of confidence and the availability of appropriate equipment in their departments. ⋯ A&E departments are better equipped with slit lamps 10 years on, and staff are being trained to use them. This has unfortunately not improved the confidence levels in dealing with eye emergencies, reflecting the lack of adequate basic ophthalmic training for A&E SHOs. Recent changes in postgraduate medical training could provide a platform to bring about the changes required.
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Comparative Study
Comparison of characteristics of admitted emergency department patients requiring cardiopulmonary resuscitation in the ICU and non-ICU setting.
Hospitalised patients requiring cardiopulmonary resuscitation (CPR) have better outcomes in intensive care units (ICUs) than wards. Survival could potentially be improved for patients at high risk for CPR if they can be identified while in the emergency department (ED) and admitted to an ICU setting. It is currently unknown whether patients requiring CPR who are admitted to the ward show a similar pattern of physiological deterioration to those admitted to the ICU, and thus whether future research should consider these two patients groups as distinct. It is hypothesised that, since both groups of patients decompensate to the point of requiring acute resuscitation shortly after hospital admission, they should also share similar premonitory signs of deterioration in their basic physiological parameters. ⋯ This study indicates that patients who experience CPR after admission to non-ICU wards may have a different pattern of physiological deterioration from patients admitted to an ICU. Further studies to derive decision criteria in admitting patients at risk for inpatient CPR should treat these patient populations as separate.
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Blast injuries to the hand are rare during peacetime and are mainly caused by fireworks. The injury patterns combine a variety of tissue destruction (laceration, dissemination, avulsion, blast, crush and burns). Emergency department staff play a key role in identifying the cause of injury, recognising the full extent of the lesion and referring patients for appropriate treatment. A review was undertaken to examine specificities in emergency department diagnosis and treatment of a separate subgroup of blast injuries. ⋯ Emergency staff must be aware of the potential dangers of this subgroup of blast injuries and the worsening effect of delay before surgery. Only knowledge of the underlying mechanism of the accident enables the emergency physician to understand the complexity and full extent of the injury pattern and to refer patients early for appropriate surgical management. Conservative treatment is inappropriate, dangerous and may become a focus of negligence claims.