Emergency and Urgent Care Services

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    Rigid bronchoscopy: a consultant survey.
    (Royal college of surgeons of england, 2023-10-16) Amlani, A; Balbirsingh, V; Giblett, Neil; Mowat, A; Parekh, M; Sandhar, P
    Introduction: Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid bronchoscopy represents the gold standard to diagnose and retrieve paediatric foreign bodies. Cases are encountered infrequently, creating anxieties about their management. Little is known about the confidence in, and maintenance of, rigid bronchoscopy skills by ear, nose and throat teams. Methods: A 15-question survey was completed by 50 practising otolaryngology consultants in England. Results: Results show that almost 40% of otolaryngology consultants covering rigid bronchoscopy have not performed bronchoscopy in more than 5 years. Consultants raised concerns about the anaesthetic support and the speed of equipment assembly. Questions on clinical practice showed disparities in practice in the same scenario. Conclusions: The authors advocate addressing many of the issues raised by the study with a greater availability of simulation courses and regular scheduled intradepartmental teaching days for all professionals involved. National guidelines on criteria for transfer to tertiary centres would improve the consistency of practice.
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    The RWT push model process.
    (The Royal Wolverhampton NHS Trust., 2023-04-25) Eve, Louise; Redding, Michelle; Wilmshurst, Sarah
    Implementation of the RWT Push Model to improve the patient journey through the Emergency department, including ambulance handover time, length of stay in the Emergency Department and a reduction in the number of patients waiting more than 12 hours.
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    Looking after the emergency medicine workforce: lessons from the pandemic.
    (BMJ Journals., 2023-02-01) Bhardway, Saurav
    No abstract available.
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    Longitudinal ultrasound image of the posterior ankle.
    (BMJ Publishing Group., 2014-08-26) Ahmad, Shoaib; Dubif, Jemima Richelle
    Anatomy quiz.
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    Delayed presentation of a traumatic bilobed pseudoaneurysm of the left ventricular outflow tract.
    (Oxford University Press, 2014-09-01) Aktuerk, Dincer; Giri, Ramesh; Matuszewski, Maciej
    A 37-year-old man presented with chest pain and shortness of breath following a high-velocity motorbike accident with blunt injury to the chest 10 months earlier. Thoracic computed tomography (CT) scan showed a communicating bilobed left ventricular (LV) pseudoaneurysm with a 6 cm (Panel A, black arrow) and 3 cm (Panel A, white arrow) aneurysm sack, respectively. Pre-operative transoesophageal echocardiography (TOE) provided a full depiction of the LV and the adjoining pseudoaneurysm, enhancing the pre-operative evaluation of the extent of the defect. It demonstrated an enlargement of the LV with two dyskinetic cavities (Panel B, black arrow, small aneurysm; white arrow, large aneurysm) localized in the diaphragmatic region. Emergency surgery was done, and revealed the communication between the smaller anterior and the larger posterior aneurysm (Panel C, asterisk). The smaller aneurysm sack was opened and retracted to visualize the LV wall defect. Repair of the defect was accomplished using a Dacron patch. Mattress sutures around the patch edges with Teflon pledgets achieved haemostasis (Panel D). Post-operative CT scan (Panel E) and TOE revealed no paraprosthetic leakage. Patient's post-operative recovery and follow-up were uneventful. LV pseudoaneurysms occur through cardiac rupture limited by surrounding pericardium. As most cases are related to myocardial infarction or cardiac surgery, traumatic LV pseudoaneurysms are rare and difficult to diagnose. Besides signs of heart failure and dyspnoea, chest pain is a common symptom. Mortality rate is high, especially in patients not undergoing surgery.