Emergency medicine journal : EMJ
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A crossover study was performed in healthy volunteers to compare the efficacy of a self-inflating bag with the Mapleson C breathing system for pre-oxygenation. ⋯ The Mapleson C breathing system is more effective and subjectively easier to breathe through than a self-inflating bag when used for pre-oxygenation. However, these benefits must be weighed against the increased level of skill required and possible complications when using a Mapleson C breathing system.
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Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP). Early diagnosis would allow more directed therapy and confidence in appropriate treatment for a majority of patients. The BinaxNOW pneumococcal urinary antigen (PNAG) test has been evaluated at laboratory level and is easy to perform and interpret, but its use as a point-of-care test has not been evaluated. A study was undertaken to assess whether PNAG testing can be reliably performed and interpreted by staff in an adult emergency department and whether rapid results influence initial treatment decisions. ⋯ PNAG diagnosis of pneumococcal pneumonia can be accurately performed as a point-of-care test by emergency department clinical staff. Without specific efforts to achieve early urine collection, the timeframe of testing will frequently fall outside the 4-hour patient stay of a UK emergency department and may be more appropriately considered as a test for the medical admissions unit in this setting. Sensitivity is at least equal to conventional culture methods and the result is available rapidly enough to potentially influence treatment decisions, a strategy that warrants further investigation.
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Paracetamol is the most common means of drug overdose in the UK. Guidance on management is available to junior doctors through TOXBASE, the online resource managed by the UK National Poisons Information Service (NPIS) and in poster form. TOXBASE is supported by NPIS units and further by a UK national rota of clinical toxicologists. A study was undertaken to examine reasons why calls about paracetamol are referred to consultants to better understand issues in managing this common poisoning. ⋯ The operation of a national consultant rota enables information on difficult or unusual cases of poisoning to be pooled so that treatment guidelines can be developed to optimise treatment throughout the UK.