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TROUBLE IN THE AIR
Emergency health professionals who travel by air will be interested in the report by Qureshi and Porter on the medical emergencies which occurred in the air over a 6 month period on a single major international airline. According to their data, when the call went out over the tannoy requesting assistance from a health professional, a doctor, nurse, or paramedic responded on most occasions. Medical emergencies in the air most often involved passengers with exacerbations of pre-existing problems, particularly of the respiratory and cardiovascular systems. Life threatening emergencies were thankfully uncommon, with the benefit (particularly from the airline’s perspective) that few flights had to be diverted. The most common causes of injury in the air were scalds from hot drinks and blunt trauma from falling luggage. Knowledgeable experts in injury prevention will clearly be found sitting next to the window enjoying a cold drink. See page 658
DANGERS OF CANNABIS
Cannabis is the mostly commonly used illicit drug in many countries. There appears to have been a previously widely held view that its use carries few health risks. Recently, however, risks of psychiatric illness have emerged and been highlighted in both the medical and popular press. In this issue, Fisher et al warn of cardiovascular complications of the drug, presenting a case and reviewing the literature. They argue that it is likely that the incidence of arrhythmias associated with cannabis is grossly underestimated. Trying to undertake research into the effects of cannabis is challenging, for a variety of obvious reasons. It is clear that much more remains to be discovered. See page 679
DIAGNOSING HYPERTENSION
Hypertension is a major risk factor for a number of serious cardiovascular and cerebrovascular problems. In the UK, general practitioners have traditionally embraced the task of diagnosing hypertension. However, there is some evidence to suggest that in certain (particularly ethnic minority) groups, there is a high proportion of individuals with undiagnosed hypertension. Taking into account the fact that many patients who attend the Emergency Department never attend a general practitioner, Fleming et al examine the feasibility of detecting hypertension in the Emergency Department. From the data presented, they argue that there is some potential for screening for hypertension in the Emergency Department. Clearly, such a proposal would be somewhat controversial. This is discussed by Lee, who in his commentary, challenges whether screening for hypertension is an appropriate function of an Emergency Department. See page 636 and 640
NURSES CAN LEAD RESUSCITATION
It is slowly being acknowledged that when it comes to the performance of practical skills by an individual within a health care setting, status and title are less important than training and capability. Gilligan et al present data to support what we (and those who run Advanced Life Support courses) have known for some time: nurses with appropriate training can match the performance of junior doctors in leading a cardiac arrest resuscitation team. Given the current staffing structure of many Emergency Departments, nurses may offer a more permanent solution to managing cardiac arrests than the increasingly ephemeral junior doctor. See page 656
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