Emergency medicine journal : EMJ
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Street Doctors is an initiative set up by Liverpool medical students in 2008. The organisation aims to reduce the morbidity and mortality associated with violent crime by equipping 'at risk' young people with basic life support and first aid skills. The high prevalence of violent crime is indicated by NHS data from 2011/12, showing that 4,490 people were admitted to hospitals across England due to assault with a sharp object. With over 120 student volunteers, Street Doctors is now established in 6 cities where knife crime is becoming a persistent and worrying concern. ⋯ These results show the positive impact that street doctors are making. The vast majority of attendees leave feeling more confident in their ability to deal with a knife or gunshot wound in the critical moments before an ambulance arrives. As an ever expanding organisation, Street Doctors has an increasing potential to pass on the valuable skills that may one day be used to save a person's life.
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In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulnerable group of patients. ⋯ Initial cuff pressures are almost all too high, needing adjustment to be in the safe zone. Dutch paramedics lack manometers and, therefore, only few paramedic intubations are followed by cuff pressure measurements. We recommend cuff pressure measurements after all (prehospital) intubations and, therefore, all ambulances need to be equipped with cuff manometers.
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We report a case of complete airway obstruction due to aspiration of muddy water. An innovative approach to clear the airway is described, which may be a potentially life saving manoeuver in similar cases of suspected muddy water aspiration.
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Paracetamol poisoning is common worldwide. Standard intravenous N-acetylcysteine (NAC) therapy is complex, and commonly associated with concentration-related adverse effects and the potential for administration errors. We aimed to determine whether adverse effect incidence could be reduced by antiemetic pre-treatment and/or a simpler and shorter intravenous N-acetylcysteine regimen. ⋯ In patients with paracetamol poisoning requiring acetylcysteine, adverse effects were substantially reduced by ondansetron pre-treatment and by using a modified, shorter treatment regimen. Ondansetron, but not the modified regimen, increased the frequency of liver function abnormalities. If large effectiveness studies confirm the modified regimen is non-inferior to conventional then shorter and safer treatment would be possible for this common poisoning.
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To describe the relationship between waiting time and patient satisfaction, and to determine predictors of overall care rating in an emergency department (ED) fast-track setting. ⋯ Waiting time was found to be highly predictive of patient satisfaction in an emergency fast-track unit with English language and NPs also associated with improved overall care rating. Future measures to improve patient satisfaction in fast-track units should focus on these factors.