Journal of accident & emergency medicine
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Since March 1992, intravenous nalbuphine hydrochloride has been used prehospital by paramedics in the Plymouth area. This study assesses the impact of this intervention. ⋯ The introduction of nalbuphine for use by paramedics in prehospital care has increased prehospital parenteral analgesia from 1% in 1992 (given by GPs only) to 3.6% in the current study group, and 41% of patients requiring parenteral analgesia received analgesia prehospital. There may be further scope for extending the indications for nalbuphine use by ambulance personnel.
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An unusual case of penetrating injury to the heart is reported. This presented late, after an initial silent period. A high index of suspicion must be maintained when chest injuries are managed conservatively. If there is doubt, a subxiphoid pericardial window may allow cardiac injury to be excluded.
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Tick bite anaphylaxis has rarely been reported. It may follow the bite of any of the different tick life cycle forms, is related to the release of salivary juices, and may range from mild itch to severe wheeze or shock. ⋯ Emergency physicians should recognise this possibility following a tick bite and be prepared to give treatment such as adrenaline rapidly. Patients should be referred to an allergist after recovery.
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Multicenter Study Comparative Study Clinical Trial
Can accident and emergency nurse practitioners interpret radiographs? A multicentre study.
To assess the ability of nurse practitioners in accident and emergency (A&E) to interpret distal limb radiographs, by comparison with senior house officers. ⋯ Nurse practitioners in A&E are able to interpret radiographs to a standard equal to senior house officers with three to five months' experience. Those nurse practitioners actively interpreting radiographs as part of their role in minor injury units are able to interpret radiographs to the same standard as senior house officers with more than five months' experience.
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A postal questionnaire was sent to all consultants and specialist trainees in the West Midlands about the use of spinal boards in the accident and emergency (A&E) department. Response rate was 70%. There was widespread use of boards in A&E despite an ATLS recommendation to the contrary. Hospitals should review their policies on use of spinal boards within the department, using the evidence available to determine the best means of immobilisation.