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Primary survey
  1. Simon Carley

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    Do we need doctors for the Ottawa ankle rules?

    If Blackham et al are to be believed, then yes. Their small but clever study shows that when patients in the ED are given the Ottawa ankle rules to use themselves they will always believe that they require an x ray; clinicians, on the other hand, disagree 10% of the time. Reassuringly, if patients cannot manage the relatively simple Ottawa ankle rules on their own then it seems that us clinicians will be needed for some time to come (see page 750).

    Nitrous is not enough

    Sedation in the ED is controversial, especially so when considering the sedation of children. Despite the increasing use and acceptance of drugs such as ketamine, there are still those who think that emergency physicians should stay away from “anaesthetic” agents and rely on other methods such as inhaled analgesia in the form of nitrous oxide (which, let’s face it, is an anaesthetic agent as well!). Anyway, in this observational study from Melbourne we find the interesting dichotomy of the parents and staff thinking that analgesia is adequate, yet a large proportion of patients clearly report high pain scores. It does therefore seem that nitrous oxide on its own is not enough to provide adequate analgesia and …

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