Journal of accident & emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine.
To establish whether there is any difference in the efficacy of a chlorpromazine regimen and a sumatriptan regimen for the management of the pain of acute severe migraine. ⋯ The chlorpromazine and sumatriptan regimens studied are both very effective for the relief of the headache of severe migraine.
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Comparative Study
Axillary brachial plexus block--an underused technique in the accident and emergency department.
To compare axillary brachial plexus block and Bier's block as methods of providing upper limb anaesthesia. ⋯ Brachial plexus blocks are an alternative form of providing upper limb anaesthesia in the accident and emergency department. They are relatively simple to perform, well tolerated by patients, and have the advantage of providing prolonged analgesia without the need for additional medication.
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To determine the number of and reasons for rapid sequence inductions done by accident and emergency (A&E) doctors out of hospital as part of the activities of the MEDIC 1 Flying Squad. "Rapid sequence induction" was defined as any attempted endotracheal intubation accompanied by use of drugs to assist intubation and ventilation, including opiates, benzodiazepines, intravenous and topical anaesthetics, and neuromuscular blocking drugs. ⋯ The lack of complications related to rapid sequence induction in prehospital care suggests that this technique is safe when done by A&E doctors on appropriate patients.
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The case is reported of a man shot with a distress flare from a range of about 3 m. The flare caused a large cavity deep in the pectoral muscles. There should be a high index of suspicion about the extent of the injury in all types of penetrating trauma.
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Comparative Study
Medical involvement in prehospital care--a transatlantic comparison.
The role of doctors in prehospital care in the United Kingdom and the USA was compared using information obtained from a visit to the city of Houston emergency medical service (Houston, Texas) and from a review of published reports. The involvement of full time specialist emergency medical services physicians has been crucial to the development of improved standards of practice within American prehospital care. The specialty of accident and emergency medicine should support provision of medical advice to the ambulance services by closer liaison with ambulance service trusts and the formalisation of training in prehospital care to specialist registrars.