Emergency medicine journal : EMJ
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A principal reason to order a head CT scan for dizziness patients is to exclude stroke. As CT imaging is substantially limited in assessing for any acute lesions other than haemorrhage, the most important stroke syndrome adequately evaluated by CT is intracerebral haemorrhage (ICH). A population based stroke database was used to assess the frequency with which ICH might mimic a benign dizziness presentation. ⋯ This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed.
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Isolated posterior ST-elevation myocardial infarction (STEMI) accounts for up to 7% of STEMIs. The diagnosis is suggested by indirect anterior-lead ECG changes. Confirmation requires presence of ST-elevation in posterior-leads (V7-V9). We investigated the ability of hospital doctors and paramedics to diagnose posterior STEMI (PMI). ⋯ A significant proportion of doctors and paramedics were unable to diagnose PMI. Hence, the majority of PMIs may be being missed. Routine use of posterior-leads in the standard assessment of patients with chest pain may identify up to an additional 7% of STEMIs, allowing prompt reperfusion therapy, which would reduce morbidity and mortality.
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To determine the capability of nurses to identify ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest. ⋯ Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training.
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To determine how far mountain rescue casualties in the UK have to be carried and the impact of adding a hoist or 'long-line' to helicopters operating in this environment. ⋯ Using the criteria that all casualties requiring a technical rescue or >400 m evacuation route to an appropriate helicopter-landing site, 34% of casualties could have been rescued using a hoist or long-line with an expected reduction in the pre-hospital time. Helicopters working in UK mountain rescue should be equipped to international standards.