Emergency medicine journal : EMJ
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Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. ⋯ Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.
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Full-shift working by senior house officers (SHOs) is well recognised as a definite constraint to effective group learning, as it is practically impossible to gather all team members together for teaching sessions at any given time. Provision of a robust weekly teaching programme is further compromised in units where relatively few doctors participate in the rota in any case. Although practical skills tuition will always demand an intensive, hands-on learning environment, teaching in relation to case-based discussion, clinical problem solving and other group activities may well be suited to more innovative methods.
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Cavernous sinus thrombophlebitis is a clinically rare but fatal disease that progresses rapidly. Its initial presentation is always neglected by emergency physicians, until typical symptoms and signs are noted or thin-slice brain CT results obtained, by which time it is already too late. ⋯ Blindness of the left eye was the outcome. High suspicion, accurate diagnosis and aggressive antibiotic treatment are emphasised.