Journal of accident & emergency medicine
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To assess the degree of inappropriate use of the London Ambulance Service and analyse the reasons for misuse. ⋯ Almost 16% of emergency ambulance calls were considered unanimously to be inappropriate. This suggests that 75,000 emergency calls per year to the London Ambulance Service are not necessary. The commonest reason for inappropriately calling an ambulance was that the caller felt that they had a serious or life threatening condition. The need for public education and deterrents of ambulance abuse are discussed. The further introduction of a nursing led triage "hot line" to appropriately dispatch ambulances according to clinical needs of the patient, and other alternatives to this are discussed.
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Hypoglossal nerve palsy (HNP) may follow fracture of the base of the skull. Of the various aetiologies described, trauma is one of the least frequent. HNP can easily be missed at the time of injury and awareness of this rare complication may assist in early diagnosis. A case of HNP after a head injury associated with the loss of taste sensation on the paralysed side of the tongue and aerocoele is reported.
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A case is described of acute torrential mitral regurgitation resulting from avulsion of both papillary muscles 12 hours after a blunt chest and abdominal injury. The intensive care and surgical management are discussed.
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Intraosseous infusion has been recommended as a rapid and effective form of circulatory access in the collapsed child. Recognised sites for insertion include the tibia, femur, iliac crest, sternum, and clavicle. The case of a 3 year old collapsed child is described who was successfully resuscitated with the use of an intraosseous needle placed in the calcaneum; the method of needle insertion is also detailed.
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Flecainide acetate is a potent class 1C antiarrhythmic agent used mainly for the treatment of supraventricular arrhythmias. Acute overdose of this drug is rare but frequently fatal. The clinical course of a patient that ingested a large quantity of flecainide as a suicide attempt is described and current therapeutic strategies discussed.