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155 000 persons have out-of-hospital cardiac arrests annually in the USA, but only 10% survive. The majority (approximately 70%) of arrests are attributed to acute myocardial infarct or pulmonary embolism. Thrombolytic therapy during resuscitation can dissolve intravascular blood clots and may improve survival. A prospective, placebo-controlled, double-blind, randomised trial in 66 emergency medical services across Europe published in the New England Journal of Medicine set out to determine whether a thrombolytic agent could improve survival from out of hospital arrests. The trial terminated prematurely for futility, with no improvement in outcome demonstrated and more intracranial haemorrhages in the thrombolytic group (N Engl J Med 2008;359:2651–62).


In the USA in the 1990s, the use of opioids for the management of chronic pain was encouraged and these drugs had a surge of popularity. Concurrently, the diversion of opioid drugs to non-medical uses (“abuses”) also increased. A study from West Virginia found that most of the unintentional overdose deaths in 2006 involved opioid analgesics. Risk factors for prescription drug deaths included being male, having less education, and living in the most impoverished counties of the …

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