Archives of emergency medicine
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One hundred and fifty-seven patients who warranted the injection of local anaesthetic were divided into two groups. One group received local anaesthetic at room temperature (21 degrees C) and the other at body temperature (37 degrees C). ⋯ There was no significant difference in the level of pain experienced by the two patient groups. It is concluded that no advantage is gained by the warming of local anaesthetic before its administration.
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Case Reports
Life-threatening stridor presenting in a patient with rheumatoid involvement of the larynx.
A case of a female patient with extensive rheumatoid arthritis who presented to the Accident and Emergency Department with life-threatening stridor is described. Although clinical involvement of the larynx is found in over a third of patients with severe rheumatoid arthritis, acute airways obstruction is fortunately a very rare complication. Stridor is probably precipitated in the acute situation in such patients as a result of upper respiratory tract infection.
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The authors describe the case history of a patient who was stabbed in the back of his neck with a knife and who later presented with a Brown-Séquard syndrome attributable to cervical spinal cord damage. Myelography and CT revealed a compressive extradural lesion shown at exploratory operation to be a loculus of cerebrospinal fluid (CSF). The loculus had formed as a consequence of leakage of CSF through a dural tear caused by the knife. ⋯ The necessity of obtaining a clear history and of performing a thorough clinical examination is explained. The need to admit patients in whom stab wounds of the neck have transgressed subcutaneous fat is reiterated. Early referral to a neurosurgeon is advised for those patients with neurological deficits.
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St Bartholomew's Hospital, in the City of London, has for many years run a Coronary Ambulance service, called by the public via the 999 system. During a 9-month period only 55% of 214 cardiac emergencies arriving at St Bartholomew's Hospital came with Coronary Ambulance support, although the service was available if called. ⋯ In addition, 153 cardiac emergencies arrived at the Accident and Emergency Department during hours when the Coronary Ambulance was not available. Reasons for breakdowns in the call-out system are discussed and remedies involving the public and London Ambulance Control are suggested.