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Sophia read with interest a recently published substudy of the ongoing Tirofiban in Myocardial Infarction trial 2, (On-TIME 2). The objectives of the substudy were to assess whether prehospital initiation of high dose tirofiban in addition to high dose clopidrogrel resulted in a more adequate inhibition of platelet aggregation and a better clinical outcome after primary PCI. The authors conclude that even after pre-treatment with high-dose clopidogrel and aspirin for up to 2 h, platelet aggregation inhibition was significantly higher when high-dose tirofiban was added to the regime. The level of platelet aggregation inhibition was related to reduced residual ST segment deviation one hour after PCI (Heart 2010;96:1815–20).
Tracheal tube placement
Despite numerous studies comparing different methods of distinguishing endotracheal and oesophageal tube placement, less evidence is available on the most accurate method of detecting endobronchial intubation. A recent prospective study published in the BMJ (2010;341:C5943) aimed to determine whether insertion depth of tracheal tube, bilateral auscultation or observation of chest wall movements was the most accurate. The authors conclude that the less experienced clinician should rely …