Journal of the Royal College of Physicians of London
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The diagnosis of acute neuromuscular paralysis includes central nervous system disorders, peripheral neuropathy, neuromuscular conduction block and muscle disease. Identification of the cause is largely a clinical problem but neurophysiological investigations are often essential and a few specific tests are helpful. The commonest cause is Guillain-Barré syndrome. ⋯ Prolonged artificial ventilation should be supervised by a specialist multidisciplinary intensive care team. Specific treatment depends on the diagnosis: for Guillain-Barré syndrome, intravenous immunoglobulin is preferred to plasma exchange on the basis of similar efficacy but greater convenience; steroids are not helpful; for myasthenia gravis, anticholinesterases and prednisolone may need to be supplemented with intravenous immunoglobulin or plasma exchange; for polymyositis, steroids are the mainstay of treatment. During convalescence patients require understanding and support in coping with residual disability.
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The aim of this study was to assess the current situation with regard to cardiopulmonary resuscitation training and organisation 10 years after guidelines were published by the Royal College of Physicians. Questionnaires were sent to 100 UK hospital trusts (88 responses) and 200 general practitioners on Wirral, Merseyside (92 responses). Most trusts gave their staff annual training in CPR, but only 80% trained all staff who came into contact with patients. ⋯ Only one practice had a defibrillator, yet 14% had needed to carry out CPR in the past 12 months. Less than half the GPs ever discussed CPR with appropriate patients. The resuscitation service in this country is fragmented, and certain areas--particularly in the training of GPs--need attention.