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  1. Ian K Maconochie, Editor
  1. Correspondence to Ian K Maconochie, Paediatric A&E Department, St Mary's Hospital London, London W2 1NY, UK; i.maconochie{at}imperial.ac.uk

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Bagging!

How effectively is bagging is the question that is looked at in this paper from researchers in Seoul. This group compared bag valve mask ventilation and the volume of delivery using a conventional bag valve mask system with one in which they had identified locations for placement of the bagger's hand. They showed that there was a huge improvement with indicating where placement of the squeezing fingers should rest–may be time for the manufacturers to think about their products! Simple but potentially very important study (see page 40).

Can you be an effective teacher without seeing fewer patients?

This US based study looks at this at this to see whether or not emergency medicine physicians could teach to ED resident's satisfaction whilst keeping up with the number of patients that they saw. The answers are illuminating and may be the study needs to be repeated in the UK setting—teaching is a fundamental part of patient care, for the patient and others such as clinicians in training (see page 37).

Elderly falls at home—what makes ambulance staff decide that they can stay at home

Falls account for an estimated 3% of NHS expenditure and are associated with morbidity and even mortality albeit in relatively few of those fallers. Up to 40% of elderly falls are not taken to the ED by ambulance crews–at the time of the study, the majority of ambulance crews in the London Ambulance Service (ie, apart from Emergency Care Practitioners) had not be formally trained to make decisions about the appropriateness of when not to take these patients to hospital. The study looks at the factors that reassure the ambulance crews to allow the elderly fall to stay at home. Interestingly, the crews feel that they are on the periphery of providing social care (see page 44).

Suddenly gone quiet

Strange thing happen and when a 40-year-old presented with acute mutism, this proved an interesting clinical conundrum which the authors resolved. Uncommon but providing a reminder to think about all possible causes for the unusual makes this case report so stimulating to read (see page 82).

Spasms galore

The management of keeping the rodent population at bay has lead to the use of nasty substances that humans make also take for whatever reason. This case looks at one of the formerly most widely used rodenticide and the effect that it had on a 49-year-old lady who took this muscle spasm inducing poison. This particular poison has been implicated in the death of Alexander the Great and in fiction, memorably in the demise of Mrs. Emily Inglethorp in Agatha Christie's The Mysterious Affair at Styles. Find out how the clinicians successfully managed this case (see page 84).

DVLA

Do you know when patients can drive or not? FY2 doctor, Dr Akhtar and consultant, Dr Saunders, looked at the knowledge amongst medical staff, nurses and doctors from a wide variety of specialities and show that we may not know as much as we think about the conditions which impede driving. Think about epilepsy, vaso-vagal syncope, stroke, seizures associated with alcohol and pre-eclampsia, look at the results of the study and go to http://www.dft.gov.uk/dvla/medical/ataglance.aspx to confirm your thoughts! (see page 85)

Recreational drugs

This pilot study analsysed the substances that were left/given by attendees at a busy inner city ED in the UK, in both liquid and solid forms and found an interesting variety of compounds. This could be of help in profiling the local activity of drug use and could inform the medical and other prevention agencies in knowing what is going on out there! (see page 11)

Swine flu

Singapore has a highly advanced healthcare system and previous experience from SARS epidemic so the paper from Tan Tock Seng Hospital is most welcome in seeing how they managed the first 50 days of swine flu. It was set up as a prospective observational study highlighting the importance that is placed in this setting on obtaining accurate and informative data. They compared with H1N1 sufferers with those who had seasonal flu and provide some suggested features that may help to differentiate the two (see page 18).

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