Multiple patients with carbon monoxide toxicity from water-pipe smoking.

This case report describes carbon monoxide toxicity from prolonged shisha (water-pipe) smoking. The evidence base for the source and pathway of toxicity is discussed. This practice has been increasing in the UK in recent years, and emergency physicians need to be aware of the high levels of CO, with the consequent risk of clinical poisoning from water-pipe smoking.

Decontamination of multiple casualties who are chemically contaminated: a challenge for acute hospitals.

Patients who have been contaminated by chemical compounds present a number of difficulties to emergency departments, in particular, the risk of secondary contamination of healthcare staff and facilities. The Department of Health in the United Kingdom has provided equipment to decontaminate chemically contaminated casualties who present at emergency departments. The capacity of this equipment is limited, and although both the ambulance and fire services have equipment to cope with mass casualties at the scene of a chemical incident, there is still the possibility that acute hospitals will be overwhelmed by large numbers of self-presenting patients. The risks and potential consequences of this gap in resilience are discussed and a number of possible practical solutions are proposed.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Capillary blood gases as an alternative to arterial puncture in diabetic ketoacidosis.

A short cut review was carried out to establish whether capillary blood rather than arterial blood can be used to assess acid base status in patients with diabetic ketoacidosis. A total of 25 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are presented in table 1. It is concluded that while the correlations in the small study found were good, there is insufficient evidence to recommend adoption of this practice in the emergency setting.