Bring back local GPs for urgent and out of hours care

No abstract: journal lette

Why do we shine lights in the eyes of conscious patients after head injury?

"Personal View", published in the BM

"Brutacaine" vanquished, but pain remains

Has “brutacaine” find its rightful place in the history books

Prehospital anaesthesia by a physician and paramedic critical care team in Southwest England

OBJECTIVES: Prehospital anaesthesia using rapid sequence induction (RSI) is carried out internationally and in the UK despite equivocal evidence of clinical benefit. It is a core skill of the prehospital critical care service established by the Great Western Ambulance Service NHS Trust (GWAS) in 2008. This retrospective analysis of the service's first 150 prehospital RSIs describes intubation success rates and complications, thereby contributing towards the ongoing debate on its role and safety. METHODS: Within the GWAS critical care team, RSI is only carried out in the presence of a qualified physician and critical care paramedic (CCP). The role of the intubating practitioner is interchangeable between physician and CCP. Data were collected retrospectively from RSI audit forms and electronic patient monitor printouts. RESULTS: GWAS physician and CCP teams undertook 150 prehospital RSIs between June 2008 and August 2011. The intubation success rate was 82, 91 and 97% for the first, second and third attempts, respectively. Successful intubation on the first attempt was achieved in 58 (85%) and 64 (78%) patients for physicians and CCPs, respectively. RSI complications included hypoxaemia (10.2%), hypotension (9.7%) and bradycardia (1.3%). CONCLUSION: Prehospital RSI can be carried out safely, with intubation success rates and complications comparable with RSI in the emergency department. The variation in the intubation success rates between individual practitioners highlights the importance of ongoing performance monitoring, coupled with high standards of clinical governance and training. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins

Rapid sequence induction of anaesthesia in UK emergency departments: A national census

Introduction: Rapid sequence induction of anaesthesia and tracheal intubation (RSI) is an integral part of modern emergency care. Previously, emergency department (ED) RSI has been provided by anaesthetists, but UK emergency physicians are increasingly developing this skill. We undertook a 2-week census of ED RSI to establish a baseline of current practice. Methods: All 115 UK College of Emergency Medicine airway leads were contacted and asked to return anonymised data on every drug-assisted intubation occurring in their ED during a 2-week period in September 2008. The number of RSIs and also the total number of ED attendances during the same period were requested. Results: Complete data were returned from 64 EDs (56%). The total number of patients undergoing RSI was 218, with an incidence of 0.12%, or approximately one in every 800 ED attendances. Anaesthetic staff undertook 80% of ED RSIs, predominantly senior anaesthetic trainees of specialist trainee year 3 (ST3) or above. During normal office hours 74% of these anaesthetic trainees were supervised during the procedure, with a significant fall in supervision rates to 15% outside normal office hours (

Why Do We Put Cervical Collars On Conscious Trauma Patients?

In this commentary we argue that fully alert, stable and co-operative trauma patients do not require the application of a semi-rigid cervical collar, even if they are suspected of underlying cervical spine fracture, unless their conscious level deteriorates or they find the short-term support of a cervical collar helpful. Despite the historical and cultural barriers that exist, the potential benefits are such that this hypothesis merits rigorous testing in well-designed research trials