BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7412.458 (Published 21 August 2003) Cite this as: BMJ 2003;327:458

Clever mathematics has shown that despite the general poor outcome of cardiac arrest in the community, rapid defibrillation by targeted but non-traditional responders is probably good value for money compared with standard emergency medical services. The data came from US casinos, which were encouraged to place sufficient defibrillators on the scene to ensure that no more than three minutes elapsed from the time of collapse. The authors say that the incidence of arrest should be considered when choosing locations for public access defibrillators (Circulation 2003;108: 697-703).

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A healthy 22 month old white boy presented with a four day history of progressive wheeze and non-productive cough. On examination he had evidence of respiratory compromise, and a chest radiograph showed air trapping on the right,suggestive of an aspirated foreign body. Bronchoscopy showed a sizeable mass of granulation tissue completely obstructing the right main bronchus and compromising the left one, and biopsies showed acid fast bacilli. He responded to debulking of the right main bronchus mass, antituberculosis therapy, and corticosteroids.Mycobacterium tuberculosis is well known for mimicking more common conditions and must be considered even in patients considered to be at low risk.

Russell A Cathcart, senior house officer, Andrew Clement,specialist …

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