Emergency medicine journal : EMJ
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To determine the scale of acute neurosurgery for severe traumatic brain injury (TBI) in childhood, and whether surgical evacuation for haematoma is achieved within four hours of presentation to an emergency department. ⋯ The system of care for severely head injured children in the UK does not achieve surgical evacuation of a significant haematoma within four hours. The recommendation to use specialist regional paediatric transfer teams delays rather than expedites the emergency service.
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Ireland's health services are undergoing dramatic reorganisation. The establishment of general practitioner (GP) out of hours cooperatives and the integration of current ambulance services into a national ambulance service are among the issues that will impact on prehospital care of emergencies. The study aimed to explore the perceptions of GPs and emergency medical technicians (EMTs) of their own and each other's roles in the context of such reforms. ⋯ Convergence between the professional groups in different geographic areas and between the disciplines across the areas is striking. They include areas of satisfaction and dissatisfaction. The need for improved liaison between the disciplines is clear.
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A teenager ingests 375 mg of glipizide and 14.5 g of melformin intentionally in a small country town. She presents to the local medical facility with symptoms and signs of hypoglycaemia. ⋯ Sulphonylurea overdose invariably results in profound hypoglycaemia that requires resuscitation with IV dextrose and the use of octreotide as an antidote. Metfonnin overdose rarely causes problems.
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Evidence on the effect of crystalloid and colloid resuscitation fluids on coagulation is confusing, with contradictory results from previous studies. This study was performed to test the effect on whole blood coagulation of a range of resuscitation fluids in vitro using a single method at a single dilution. ⋯ Some resuscitation fluids have a profound effect on coagulation. The confusion in the literature may result from the effect on coagulation being both fluid and dilution dependent, with no simple crystalloid/colloid split.
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The National Acute Spinal Cord Injuries Studies and the Cochrane Review advocate the administration of high dose methylprednisolone following acute traumatic spinal cord injury. However, controversy surrounds its use and approaches between different units are often inconsistent. ⋯ Currently practice varies in the UK regarding the immediate use of methylprednisolone after spinal injury. Clear guidelines need to be established to achieve a more consistent approach.