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Primary survey
  1. Jonathan Wyatt, Deputy Editor

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    Risks of CT

    A few years ago, it was considered to be a bit of a novelty to manage to obtain an emergency computerised tomography scan. Today, you could be forgiven for the impression that CT is not infrequently used as an alternative for thorough clinical assessment. This is particularly true of patients who present following blunt trauma, where whole body screening appears to be increasingly pursued. Concerns about the potential radiation risks associated with a more widespread use of CT form the thrust of the second commentary in this issue. The figures presented relating to the additional lifetime risk of cancer are quite frightening (see page 323).

    Time called on capillary refill

    Most of us have become accustomed to routinely checking capillary refill time as part of clinical assessment to search for possible hypovolaemic shock. However, in a challenging commentary, Jonathan Lewin and Ian Maconochie review the evidence and suggest that there is little scientific basis for its use in adults (see page 325). They outline how checking capillary refill time in adult patients found its way into modern medical practice over a 50-year period in a seemingly haphazard way.

    ECG telemetry

    Thrombolysis plays a crucial role in the treatment of acute myocardial infarction in many parts of the world. Considering the need to give it as soon as possible after symptoms start, it is natural that prehospital thrombolysis has become quite popular. McLean et al report on their experience of providing prehospital thrombolysis to a large number of patients in Scotland (see page 370). Interestingly, they employed telemetry support using nurses in the Coronary Care Unit rather than medical support from the ED.

    In the past, we never talked about it

    Those who have been involved in unsuccessful resuscitations will be only too aware of the effect that it can have on members of the team. This is particularly apparent when the patient who dies is a child. The concept of debriefing after critical incidents has been around for some time. However, research reveals that debriefing is not being regularly practised following failed paediatric resuscitations in the UK setting. Proposals are presented which aim to introduce structured debriefing to cover both medical and psychological issues. Practical problems remain—particularly in relation to either managing the “backlog” of patients waiting to be seen in the ED after a prolonged resuscitation or formally reassembling the same resuscitation team at a later date (see page 328).

    Statistics made easy

    One of the qualities of a great teacher is the ability to turn those things which appear to be really complicated into something vaguely understandable. Statistics are regarded as being a bit of a mystery by many practitioners, despite the acknowledgement that they have an essential role in research. On this basis, we hope that readers of the journal will find the second article in our Critical Appraisal Series to be useful and refreshing (see page 362). And if you find yourself getting “horribly bogged down”, Steve Goodacre urges you to “remember that the statistics are supposed to be there to help you”.

    Prehospital temperature control

    This month’s reflections on prehospital care cover problems relating to temperature control. It may come as a surprise to those who have not visited the country, but these reflections come from South Africa, where it does get quite cold at night! It has previously been established that hypothermia is deleterious in trauma patients. Two cases are presented, together with a description of how to try to avoid hypothermia related damage (see page 375).

    Taser damage

    A wide range of injuries and effects have previously been reported in the medical literature following deployment of Taser guns. These include arrhythmias, burns, barb ingestion, testicular torsion and spontaneous abortion. We can now add pharyngeal perforation (see page 378).


    Finally, this month’s BETs address some interesting questions relating to a couple of drugs which have traditionally caused a certain amount of controversy (see pages 365 ARTICLE ARTICLE–9). Two have a ketamine flavour to them, whilst the other involves heliox.

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