PRIMARY SURVEY
Primary Survey
WEIGHTY ISSUES
We keep hearing in the general press that children are getting heavier and this has led to criticism of the use of standard formulae to estimate the weight of children who present to hospital in an emergency. Perhaps it is time to forget all those traditional formulae and methods of estimating childrens weight and try something new? This is the line taken by Krieser and colleagues from Australia, with interesting results.
See pages 756
VIOLENCE TOWARDS PARAMEDICS
Another study from Australia reports on a worrying aspect of front line emergency care. The nature of working as a paramedic requires the ability to be decisive under pressure in an often clinically challenging setting. But this setting is rendered even more difficult as a result of aggressive acts being aimed against paramedics. These aggressive acts include damage to property, verbal and physical abuse, but also sexual harassment and even sexual assault.
See pages 760
KETAMINE CONTROVERSY
The mere mention of ketamine is usually enough to provoke lively discussion. Its analgesic and airway protective properties make it an attractive choice for certain prehospital predicaments, but its role in patients with head injury does remain controversial. These issues are explored in a report on page 794.
POISONING
Two papers underline the important role that Poison Centres play in helping to provide advice to treat poisoned patients. Physicians from an urban Emergency Department report two cases of envenomation from exotic snake bites in which the local Poison Centre played a key part in the delivery of treatment. The reports also serve as a reminder of the unusual challenges that emergency physicians can face.
See pages 796
Consensus guidelines have been published regarding the role of gut decontamination using various techniques, but how much do physicians actually know about them? This issue is addressed in a separate study which examines the knowledge that physicians from various backgrounds have in relation to various treatments for poisonings. The results might seem a little disappointing, but the bottom line is that the Poison Centres are always there to provide the answers.
See pages 774
ANIMAL EXPERIMENTATION
Gunshot chest injuries extact a tremendous toll on mankind, both in civilian and military settings. Identifying the optimum treatment is a key objective for those providing care for people who sustain life-threatening penetrating cardiac gunshot injuries. A paper from China reports on the experience of using emergency cardiopulmonary bypass in the treatment of penetrating cardiac gunshot wounds in an animal model (see page 764). The animals that were used (sacrificed) were dogs. Some readers may consider the methods used to be distasteful, or perhaps even unethical. In an accompanying commentary, Bernard Foëx explores these issues, with particular reference to philosophical and historical perspectives. Whether or not you agree with the arguments presented, they certainly make interesting reading (see page 750).
TELEMEDICINE
Considering the continuing technological developments in Emergency Medicine, it should come as no surprise to find two articles on telemedicine in this issue. The first, from the Welsh Burn Centre, goes in the face of politically correct behaviour. Just when you thought that you should turn off your mobile phone within the hospital, heres a report suggesting that there are times when you might like to leave it on. The authors report on the possible benefits of a camera-equipped mobile phone for the assessment of burns.
See pages 753
The second paper, by Binks and Benger, explores the use of tele-education in emergency care. They demonstrate how telemedicine has already a significant educational role within Emergency Medicine, but argue that there is plenty of potential to go much further.
See pages 782
Relevant Articles
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The ethics of animal experimentation
Emerg. Med. J. 2007 24: 750-751.[Extract] [Full Text] [PDF]
- Mobile phones for the assessment of burns: we have the technology
- Kayvan Shokrollahi, Mobin Sayed, William Dickson, Tom Potokar
Emerg. Med. J. 2007 24: 753-755.[Abstract] [Full Text] [PDF]
- Parental weight estimation of their childs weight is more accurate than other weight estimation methods for determining childrens weight in an emergency department?
- David Krieser, Kevin Nguyen, Debra Kerr, Damien Jolley, Megan Clooney, Anne-Maree Kelly
Emerg. Med. J. 2007 24: 756-759.[Abstract] [Full Text] [PDF]
- A pilot study of workplace violence towards paramedics
- Malcolm Boyle, Stella Koritsas, Jan Coles, Janet Stanley
Emerg. Med. J. 2007 24: 760-763.[Abstract] [Full Text] [PDF]
- Emergent cardiopulmonary bypass in canines with penetrating cardiac wounds caused by gunshot
- Jinzhou Zhang, Wen Wang, Wensheng Chen, Hailong Zhu, Jincheng Liu, Guocheng Sun, Qin Cui, Weiyong Liu, Dinghua Yi
Emerg. Med. J. 2007 24: 764-768.[Abstract] [Full Text] [PDF]
- Gut decontamination of acutely poisoned patients: what do doctors really know about it?
- David Michael Wood, Shaun L Greene, Alison Linda Jones, Paul Ivor Dargan
Emerg. Med. J. 2007 24: 774-775.[Abstract] [Full Text] [PDF]
- Tele-education in emergency care
- S Binks, J Benger
Emerg. Med. J. 2007 24: 782-784.[Abstract] [Full Text] [PDF]
- Trench entrapment: is ketamine safe to use for sedation in head injury?
- Matthew Gunning, Zane Perkins, Tom Quinn
Emerg. Med. J. 2007 24: 794-795.[Extract] [Full Text] [PDF]
- Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments
- Carol Lubich, Edward P Krenzelok
Emerg. Med. J. 2007 24: 796-797.[Abstract] [Full Text] [PDF]
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