Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

The ideal position for performing surgical cricothyroidotomy is with full neck extension. Some authors have recommended marking the cricothyroid membrane before general anaesthesia, typically with the patient's head and neck in a neutral position. The primary aim of this observational study was to determine whether skin marks made over the centre of the cricothyroid membrane with the head and neck in the neutral position moved outside the boundaries of the membrane when the neck was subsequently extended. The secondary aim was to assess changes in the height of the cricothyroid membrane between the neutral and extended positions. Twenty-two volunteers completed the study. With the head and neck in the neutral position, the distance between the upper and lower borders ('height') of the cricothyroid membrane was measured by a radiologist using ultrasound. The skin was marked over the mid-point of the membrane. The subject then maximally extended the neck, and the measurements and marking were repeated. The skin marking over the centre point of the cricothyroid membrane moved by median (IQR [range]) 5 (4-6 [0-10]) mm when the head and neck were moved from a neutral to a fully extended position. The initial skin mark moved to lie outside the boundary of the cricothyroid membrane in 12 of 22 subjects after extending the neck. The height of the cricothyroid membrane increased by 30% with the neck extended. We recommend that marking the skin in preparation for cricothyroidotomy should be performed with the neck extended, not with the head and neck in the neutral position as previously suggested.

This was a retrospective study examining 60 surgically excised Morton's neuromas from 53 patients over a period of three years at Southend University Hospital, Essex. The initial diagnosis of Morton's neuroma was based on history and examination findings. In only one-third of cases was the neuroma palpable. However, many patients had difficulty localizing the pain and had atypical presentation. We attempted to assess the reliability of ultrasound in diagnosing Morton's neuroma in the 60 histologically confirmed cases. Our second objective was to assess whether size estimate of a neuroma seen on ultrasound correlated with subsequent real specimen measurement. In our study, preoperative ultrasound reliably diagnosed Morton's neuroma in 97% of the cases. In contrast, there was poor correlation in real specimen size measurements when compared with ultrasound reports.

Postmortem hypostasis (livor mortis or lividity) is classically defined as the intravascular pooling of blood in gravitationally dependent parts of the body after death. However, intense lividity can be associated with small hemorrhages in the skin, so-called postmortem hypostatic hemorrhages (Tardieu spots). Postmortem hypostatic hemorrhages seem to contradict the usual understanding of lividity, since hemorrhage is by definition an extravascular phenomenon. Substantive medicolegal difficulties can arise if such hemorrhagic lividity develops in the necks of bodies that have ventral lividity due to prone position at the death scene. To study this phenomenon, we have developed a model for the controlled formation of hypostatic hemorrhages in human cadavers. In this model, extensive hypostatic hemorrhages or hemorrhagic lividity could be reproducibly but not universally induced in the soft tissues of the anterior neck and strap muscles. Histologic examination revealed hemorrhage that was microscopically indistinguishable from the acute hemorrhages observed in contusions. In addition, some larger areas of interstitially extravasated blood showed "buffy coat"-sedimentation separation of neutrophils that closely mimicked acute inflammation, further confounding the correct diagnosis. This research implies that hypostatic hemorrhages form after the progressive development of increasing gravitational hydrostatic pressure in an autolysing venous plexus. Thus, this phenomenon can mimic soft tissue injury ("pseudo-bruising") and the internal injuries related to strangulation. Caution must be exercised when diagnosing strangulation in bodies with anterior neck lividity.

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