Emergency department staff will often need to clinically assess an injured patient’s level of alcohol intoxication, but how well does such an assessment correlate with blood alcohol concentration? Cherpital and colleagues studied over 4000 patients across 12 countries and concluded that clinical assessment is moderately concordant with blood alcohol concentration, but concordance was lower among patients who had been drinking in the previous 6 hours. They ascribe this to a tendency for clinicians to diagnose intoxication in any patient who had been drinking.
See p 689

When someone dies suddenly we are often asked what the likely cause of death was. Mushtaq and co-workers present data suggesting that this judgement should be made with caution. In a series of 63 patients who died suddenly and subsequently underwent post-mortem examination, the cause of death identified by the most senior clinician was inaccurate in 40%. Pulmonary thromboembolism in particular was both over-identified and under-identified.
See p 718

Emergency care if constantly changing. Locker and colleagues studied emergency department attendances in Sheffield, United Kingdom, from 1993 to 2003. The proportion of older patients, arrivals by emergency ambulance, "major" cases, and those admitted all increased during this time. As a consequence, the median waiting time more than doubled over the same period. Recent initiatives and increased resources may have reduced waiting times since then, but maintaining improvement will be difficult against this trend of increasing workload.
See p 710

Outpatient treatment of cellulitis with intravenous antibiotics is now standard practice in some departments. Donald et al, report their experience over 1 year of treating 124 patients with cellulitis as outpatients with cephazolin 2g twice daily. Treatment was successful in 85%, with the remaining 15% requiring admission. Mean duration of treatment was 6 days.
See p 715

Changing practice can be frustratingly difficult to achieve, even when a new intervention is supported by evidence from randomised trials. Qualitative methods can provide valuable insights into the potential barriers to change. Price and colleagues interviewed 20 paramedics to explore their attitudes to providing prehospital thrombolysis. The paramedics appreciated the potential benefits of thrombolysis, but identified a number of personal and organisational factors that may discourage its use.
See p 738

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