Emergency medicine journal : EMJ
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Multicenter Study
Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties.
Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. ⋯ Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process.
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Review
Best evidence topic report. Nebulised levalbuterol or albuterol for lowering serum potassium.
A short cut review was carried out to establish whether nebulised levalbuterol is better than or equivalent to albuterol for lowering serum potassium. Seven papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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A short cut review was carried out to establish whether the Bone Injection Gun is better than a standard intraosseous (IO) needle at obtaining IO access. A total of 129 papers were found using the reported search, of which three represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Shoulder dislocations account for almost 50% of all joint dislocations, which are most commonly anterior (90-98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the scapular manipulation technique (SMT) to reduce traumatic anterior shoulder dislocations. ⋯ We report the successful use of SMT in the prone position for the reduction of traumatic anterior shoulder dislocations, mainly without requirement of any sedatives or opiate analgesics. We believe that SMT may also be applied by inexperienced physicians, as it is simple, applicable, and easily understood. As no single method has a 100% success rate, SMT is a useful one to know.
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To develop a standard for safe patient referral from emergency medicine (EM) staff to hospital inpatient specialities; to audit adherence to that standard, and from this audit, to identify potential risk areas in this aspect of patient care; to make recommendations for reducing such risks; and to implement those recommendations. ⋯ Referral is an important skill for many doctors, particularly those in EM. It requires teaching and practice. The corollary to this is that education in this arena is also essential for those receiving referrals, to ensure smooth communication and safe systems of handover for patients.