Journal of accident & emergency medicine最新文献

{"title":"Journal scan","authors":"J. Wardrope, S. Rothwell","doi":"10.1136/emj.17.4.289","DOIUrl":"https://doi.org/10.1136/emj.17.4.289","url":null,"abstract":"Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial A Furlan, R Higashida, L Wechsler, et al JAMA 1999;282:2003–11 Randomised, controlled, multicentre, open label trial with blinded follow up determining the clinical eYcacy of intra-arterial prourokinase in patients with acute stroke caused by occlusion of the middle cerebral artery. Only those patients for whom treatment could be initiated within six hours of the onset of symptoms were included. A total of 180 patients were recruited, all of whom passed computed tomography (CT) and cerebral angiography criteria, and were randomised to receive either intra-arterial prourokinase and intravenous heparin or intravenous heparin alone. A second angiogram was performed at two hours and CT scans were performed at baseline, 24 hours and 7 to 10 days after initial treatment. The primary outcome, defined by a modified Rankin score (a score of disability), was the proportion of patients with slight or no neurological disability at 90 days. Secondary outcomes included MCA recanalisation, frequency of intracranial haemorrhage and mortality. Results showed better neurological outcome in the treatment group with 40% of prourokinase patients and 25% of controls having a modified Rankin score of 2 or less at 90 days. Intracranial haemorrhage with neurological deterioration occurred in 10% of prourokinase patients and 2% of controls, but overall mortality was essentially equal, with 25% and 27% in the respective groups. Critique—There is a great deal of interest in the role of thrombolysis in acute ischaemic stoke. The evidence so far seems to indicate that neurological outcome can be improved if the treatment is given early but with a real increased risk of intracranial haemorrhage. Intravenous thrombolysis seems to have benefit only if given within three hours of onset of symptoms. The PROACT II trial achieved its goal of demonstrating the possibility of extending the therapeutic window to six hours by the use of intra-arterial injection. This study screened over 12 000 stroke patients to leave a study population of 180. A total of 4000 were excluded as longer than six hours had elapsed since onset of symptoms. The great exclusion rate does question the utlility of this treatment even in the USA where there is much easier access to cerebral angiography expertise. It would not be practical in the UK. The benefits, even in this trial remain marginal against a background of much increased risk of significant intra-cranial bleeding. This is an area where research will continue but there is not enough present evidence to recommend widespread use of thrombolysis in stroke.","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64230397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical anaesthesia use in the management of children's lacerations, a postal survey.","authors":"S Bush","doi":"10.1136/emj.17.4.310-a","DOIUrl":"https://doi.org/10.1136/emj.17.4.310-a","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.310-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous pneumothorax: is it under tension?","authors":"V J Holloway,&nbsp;J K Harris","doi":"10.1136/emj.17.3.222","DOIUrl":"https://doi.org/10.1136/emj.17.3.222","url":null,"abstract":"<p><p>A diagnosis of tension pneumothorax is usually only considered within the context of trauma, incorrect chest drain insertion or positive pressure ventilation. Four patients are presented who developed spontaneous tension pneumothorax with no precipitating factors. In three of these instances, the diagnosis was only made radiologically and in every case the treating physician was unaware that a spontaneous tension pneumothorax could occur. Previously, emphasis has been placed on tracheal deviation in a tension pneumothorax. However, this is an inconsistent finding as one of the cases highlights. Patients may appear surprisingly clinically well until they decompensate. These cases are highlighted to raise awareness of this potentially life threatening condition.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedestrian injuries sustained in negotiating traffic calming measures.","authors":"K Rajesh,&nbsp;M E Lovell","doi":"10.1136/emj.17.3.233-a","DOIUrl":"https://doi.org/10.1136/emj.17.3.233-a","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.233-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echoes of things to come. Ultrasound in UK emergency medicine practice.","authors":"J Brenchley,&nbsp;J P Sloan,&nbsp;P K Thompson","doi":"10.1136/emj.17.3.170","DOIUrl":"https://doi.org/10.1136/emj.17.3.170","url":null,"abstract":"<p><p>Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised \"primary\" indications for ultrasound in emergency medicine. In this paper current evidence supporting the implementation and use of emergency ultrasound in these primary conditions and possible other indications are assessed. The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aorto caval fistula--the \"bursting heart syndrome\".","authors":"S Leigh-Smith,&nbsp;R C Smith","doi":"10.1136/emj.17.3.223","DOIUrl":"https://doi.org/10.1136/emj.17.3.223","url":null,"abstract":"<p><p>Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of an assault patient questionnaire to allow accident and emergency departments to contribute to Crime and Disorder Act local crime audits.","authors":"V Goodwin,&nbsp;J P Shepherd","doi":"10.1136/emj.17.3.196","DOIUrl":"https://doi.org/10.1136/emj.17.3.196","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and refine an assault patient questionnaire to facilitate the contribution of accident and emergency (A&E) departments to Crime and Disorder Act local crime audits.</p><p><strong>Method: </strong>A brief nine item questionnaire was devised in collaboration with the authors of the Home Office British Crime Survey. A prospective sample of 46 consecutive assault patients who attended Cardiff Royal Infirmary A&E department were interviewed by either reception staff or triage nurses. The questionnaire was revised appropriately.</p><p><strong>Results: </strong>The collection of information in A&E departments about the circumstances of violence was straightforward. Questions about motive for violence and about relationships between the injured and their assailants were problematic.</p><p><strong>Conclusion: </strong>The collection of information relevant to Crime and Disorder Act crime audits was possible without extra resource. Receptionists were found to be the most appropriate staff to record information.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Corticosteroids in acute spinal cord injury.","authors":"P Wallman,&nbsp;K Mackway-Jones","doi":"10.1136/emj.17.3.215","DOIUrl":"https://doi.org/10.1136/emj.17.3.215","url":null,"abstract":"Report by Paul Wallman, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant \u0000\u0000A 40 year old man is involved in a road traffic accident. He has bony disruption at C7/T1 with acute spinal cord injury. He has no associated head injury and no other life threatening …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of pilonidal sinus.","authors":"J P Sloan,&nbsp;J Brenchley","doi":"10.1136/emj.17.3.232","DOIUrl":"https://doi.org/10.1136/emj.17.3.232","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Troponin T to rule out myocardial damage in chest pain.","authors":"K Richell-Herren,&nbsp;S Maurice","doi":"10.1136/emj.17.3.213","DOIUrl":"https://doi.org/10.1136/emj.17.3.213","url":null,"abstract":"Report by Katrina Richell-Herren, Research Fellow Search checked by Sue Maurice, Consultant \u0000\u0000A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}