Tim Martindale

The effects of a high carbon dioxide on cerebral perfusion and intracranial pressure are well known. We report the case of a man who presented after with a severe traumatic brain injury including intracranial and extradural haemorrhage. Neuroprotective ventilation was impossible without supramaximal tidal volumes due to a combination of chest trauma and severe bronchospasm. A pump driven Novalung iLA active® system was inserted to achieve both ARDSnet ventilation and a lowering of intracranial pressure. To our knowledge, this is the first time this system has been used to this effect. The patient went on to make a good recovery.

In response to a sense of ‘crisis’ in global fisheries, contemporary policies and social science accounts have tended to approach fishery ‘problems’ in terms of models derived from biology and resource-economics. Through a study of the fishing industry in Cornwall, UK, this thesis contributes an alternative perspective – examining how knowledges and meanings attached to the work of fishing are reproduced in the context of wider social relations and economies. Processes of European rural re-structuring, increasing costs and restricted access, have recently exacerbated more long-term trends of decline in Cornish fisheries. However social change and new media for knowledge transmission also contribute to the remaking and reinvention of fishing livelihoods and ideologies. The study is based on a historical ethnographic methodology which included archival research, participant observation, unstructured interviews and life-histories.
\nFrom the late nineteenth century the marginalisation of Cornwall’s fishing and maritime economy accompanied the ‘discovery’ and idealisation of Cornish fishing villages through art and tourism. Social distance and inequality in fishing villages grew but so also did new forms of co-dependency. More recently conflict has emerged around the politics of the environment, and fishers’ knowledges point to the unpredictability of fishing ecologies and economies, suggesting the potential for alternative management models. Narratives about skill, craft and expertise play a role in how some producers in Cornwall reproduce themselves as independent fishermen and reflect a concern that such skills and dispositions are passed on to future generations. Others have diversified into forms of art and craft production – activities which shape memory and sense of place whilst replicating notions of self- sufficiency. I argue for the potential constructiveness of forms of heritage practice which can be both a source of critical nostalgia and an imaginative approach to the past as a resource for the regeneration of regional maritime economies. Whilst meanings and ideologies attached to the work of fishing in Cornwall may serve as markers of loss or of conflicts around knowledge production, or may mask systemic inequalities, they can also be a source of innovation, reward and creativity

We present the case of a diver who experienced an uncontrolled ascent from 55 m and presented with a severe decompression illness. She was clinically shocked and in multi organ failure due to massive fluid shifts. She demonstrated bilateral lower limb loss of power and sensation and required multiple hyperbaric therapy sessions. With joint critical care, hyperbaric and physical therapy involvement, she was discharged some five weeks after her presentation with an independent level of function.

Respiratory medicine has a lot to offer the trainee. It’s a great mixture of both acute and chronic illnesses, from the young with asthma and pneumonia to older patients with chronic obstructive pulmonary disease (COPD) and lung cancer. There are practical procedures aplenty, and you will get very good at arterial blood gases (ABGs) and get the chance to perform invasive procedures such as chest drains; often as the ‘Respiratory SHO’, you get bleeped to insert them for other teams. There’s a lot of the social side too, and that invariably includes relatives and the emotion that goes with a new diagnosis of cancer or just the