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  1. Jonathan Wyatt1,
  2. Fiona Beech2
  1. 1Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK
  2. 2Emergency Department, Royal United Hospital, Bath, UK
  1. Correspondence to:
 Mr J P Wyatt;

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Edited by Jonathan Wyatt; this scan coordinated by Fiona Beech

Rapid extrication from car wreckage ▸

Prehospital emergency services are constantly striving to remove injured patients from car crash wreckage as quickly as possible. This Norwegian study focused upon extrication from frontal/oblique impact collisions. Standard extrication techniques are based upon cutting the pillars around the windows, removing the roof, and spreading the wreckage. The authors propose a new extrication technique that is based on attempting to reverse the forces of the original crash: the rear of the car is anchored and the steering wheel and the front of the car are pulled forwards in a controlled fashion. Car crashes were simulated in a range of vehicles and rescue teams were randomised to use standard procedures or the new proposed procedure. The time to extrication was significantly shorter with the new method and no additional uncontrolled movements were encountered. The authors do acknowledge some practical problems, such as the need for a certain amount of space around the wreckage, but they are optimistic about the future role of this technique. Clinical trials may provide the answer.

Death by prehospital hyperventilation ▸

It has been observed that professional rescuers in out of hospital cardiac arrest consistently hyperventilate their patients. It is postulated that this raises intrathoracic pressure, with resultant reduced cardiac output and coronary perfusion. Other possible adverse effects include cerebral vasoconstriction and a shift of the oxygen-haemoglobin dissociation curve to the left. This paper set out to investigate this clinically and to test whether hyperventilation has a negative effect on outcome after cardiac arrest in …

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