Emergency medicine journal : EMJ
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To assess whether the co-ingestion of opiates in acute paracetamol overdose has an effect on the paracetamol level 4 h after ingestion. ⋯ Co-ingestion of opiate decreases the serum paracetamol level at 4 h. If opiate and paracetamol are taken together, there is a case for a repeat measurement of the paracetamol level if the level at 4 h is lower than would be expected in selected patients.
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A 62-year-old man presented 6 h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. ⋯ Over the following 24 h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures.
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Paediatric head injury is a common presentation to emergency departments (ED), and the 2007 National Institute for Health and Clinical Excellence head injury guidelines included a paediatric section to deal with this. This is based on the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head injury rule. To date, no studies have examined the impact of the guideline on ED resources. ⋯ The cost effect of an extra 21 CT scans per annum is estimated at £3570. This is offset against a potential cost saving on admissions of £10 450. The neoplasia risks of increased scanning are also discussed. Problems in this study were the preference for admission over scanning in children who qualified for scan under both guidelines and absent data from clinical records. Further work could include a prospective study of the guideline.
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All emergency departments (EDs) should be adequately equipped and prepared to deal with unexpected neonatal deliveries and resuscitation. A study was undertaken to determine what neonatal resuscitation equipment is available in EDs in the UK and to formulate recommendations for improvement. ⋯ There is a good level of provision of neonatal resuscitation equipment in UK EDs, although certain areas need to be addressed. There is a particular need for improving the provision of warming and advanced airway equipment. The authors consider that it is not necessary to have a neonatal Resuscitaire in the ED provided other equipment is readily available. The findings of this survey prompt the recommendation that all EDs should review their neonatal resuscitation equipment in accordance with APLS guidance, and ensure that staff have immediate access to this equipment and are comfortable with its use.
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The Australian healthcare system at all levels is under increasing pressure. The Australian paramedic discipline has seen a remarkable change in a number of areas including education, training, healthcare identity and clinical practice, particularly over the past three decades. Preparing future healthcare graduates for these expected changes therefore requires careful alignment of graduate attributes to core curriculum. ⋯ It is critical that empirically-based paramedic graduate attributes are developed and agreed upon by both the industry and teaching institutions. Until this occurs, the national standardisation, accreditation and benchmarking of Australian paramedic education programmes will not be possible.