Intended for healthcare professionals


On the house

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:0

Plenty in this week's journal for accident and emergency departments and those who refer people there. Patients with suspected myocardial infarction make up a sizeable proportion of emergency admissions, yet fewer than half will have high risk coronary heart disease. Could these “Chest pain”—please admit's be safely referred to a rapid assessment chest pain service instead? Cohort studies have been promising; now what is needed is a randomised controlled trial say Simon Capewell and John McMurray in their editorial(p 951).

Patients with status epilepticus begin their often hazardous journeys through hospital at the accident and emergency department. As early treatment means easier control, these departments should have treatment protocols, argues M T E Heafield. He discusses the benefits of fosphenytoin, a prodrug of phenytoin, which has recently been licensed in the United Kingdom (p 953).The stakes are high: continued seizure activity in status epilepticus means neuronal damage.

Desiree Choi and colleagues report the reassuring finding that the Royal London Hospital prescribed analgesia to similar proportions of white and Bangladeshi patients with isolated long bone fractures (p 980). An earlier study in an emergency department in Los Angeles had reported ethnic differences in the prescription of analgesia.

In the letters pages correspondents discuss some unresolved questions in prehospital emergency care. Should it be “stay and play” or “load and go,” and who should do what? Paramedic John Warwick regrets that the “original aspirations of our worthy fathers were overtaken by political posturing.” The original concept had been for a small cadre of highly trained paramedics, but the 1989 ambulance dispute ended with the promise of a paramedic in every vehicle. Simple improvements—such as good direct communication between the receiving hospital and the ambulance crew—have yet to be achieved (p 1005).

But even before optimal prehospital emergency care comes the need for prevention. That message emerges from the results of a questionnaire of Scottish students about drug use and weapon carrying (p 982). Some 34% of males and 8.6% of females aged 11-16 years reported having carried a weapon. Weapons were classified as bladed (knives (flick, switch, Stanley, craft, or hunting), machete, sword, razor) or non-bladed (guns (air rifle, pistol, replica), blunt instruments (club, metal pipe), sports equipment (baseball bat, snooker cue), tools (screwdriver, hammer), and other weapons (catapult, knuckleduster)).

“O tempora, O morags!” as Jeff Aronson's spelling chequer might have had it (p 990).


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