Primary Survey
Many of the EMJ’s readers will be familiar with the apparently increasingly frequent presentation of patients to the emergency services complaining that one of their drinks has been spiked. It is certainly something which has aroused some public concern, especially amongst those who enjoy going out for a drink. Many patients presenting with the claim that their drinks were spiked do appear to be rather unwell. However, the exact nature of the agent responsible has not been clear, until now, that is.
See page 89
Historical observers might be excused for concluding that it took rather a long time for those responsible for organising emergency medical services to wake up to the fact that the best outcome after out of hospital cardiac arrest lies with definitive prehospital care, not with rapid transfer to hospital. Having acknowledged this, arguments have focused upon the nature of skills required by paramedics. Woodall and colleagues report their experience from Queensland, Australia in order to inform the debate. They argue for the role of highly trained paramedics with advanced life support skills.
See page 134
The review article this month focuses upon the prehospital management of patients with pelvic fractures. This has tended to be an area of prehospital care with much divided opinion, particularly in relation to intravenous fluid replacement, pneumatic anti-shock garments and other methods of splintage. The authors consider and summarise the evidence, then produce practical guidance.
See page 130
Concern about the life-threatening potential of "plastic bullets" as previously used by the army and police in the UK has led to a search for safer alternatives. A paper from Northern Ireland reports on injuries sustained from the latest development. This is the attenuated energy projectile, and is composed of polyurethane, with a crumple zone involving an air gap in the nose.
See page 103
Those who enjoyed the initial offering will be pleased to welcome back another episode of the Synopsis of Cochrane Reviews Applicable to Emergency Services. The group report and summarise relevant reviews with a cardiac theme ranging from the role of active compression-decompression cardiopulmonary resuscitation to the role of hyperbaric oxygen for acute coronary syndrome.
See page 115
More patients are enjoying the advantages of implantable defibrillators, which include staying alive for longer. Emergency practitioners may not be quite up to speed with how to handle patients who present after defibrillator discharge. If so, they may be interested to hear the experience of Liu and colleagues who report from Taiwan on their experience of patients presenting to the emergency department with a range of implantable defibrillator related problems.
See page 106
Established septic arthritis can have devastating long-term effects upon limb function, underlining the importance of early detection of the condition. Unfortunately, this is often easier said than done. The combination of clinical findings and results of investigations can be notoriously difficult to interpret. The value of various investigations is reported in this issue.
See page 75
The general public have already been alerted to possible (and arguably as yet unproven) risks of mobile phones to the brain. In an interesting report, a team from Essex advise of potential problems associated with eating part of a mobile phone. SIM cards, it seems, don’t work so well when ingested and separated from the rest of the phone.
See page 142
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