Journal of accident & emergency medicine最新文献

{"title":"Non-penetrating chest blows and sudden death in the young.","authors":"S Thakore,&nbsp;M Johnston,&nbsp;E Rogena,&nbsp;Z Peng,&nbsp;D Sadler","doi":"10.1136/emj.17.6.421","DOIUrl":"https://doi.org/10.1136/emj.17.6.421","url":null,"abstract":"<p><p>Sudden death in the young after low energy anterior chest wall impact is an under-recognised phenomenon in this country. Review of the literature yields several American references to commotio cordis, mainly in the context of sporting events. Two cases are reported of sudden death in young men as a result of blunt impact anterior chest wall trauma. It is suggested that these cases draw attention to a lethal condition of which many practitioners are unaware.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927755","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 Millennium Scientific Meeting, Manchester, 9–11 October 2000 (Hosted by the Faculty of Accident and Emergency Medicine)","authors":"N. Hjelm, R. Cocks","doi":"10.1136/emj.17.6.434","DOIUrl":"https://doi.org/10.1136/emj.17.6.434","url":null,"abstract":"The Millennium Scientific Meeting, Manchester, 9–11 October 2000 (Hosted by the Faculty of Accident and Emergency Medicine) EMRS/SSL International plc Prize Session Use of plasma DNA analysis to derive early prediction rules for post-traumatic organ failure T H RAINER, Y M D LO, L Y S CHAN, P K W LAM, E K WONG, N M HJELM, R A COCKS Accident and Emergency Medicine Academic Unit and Department of Chemical Pathology,The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong Background—The discovery of eVective treatments preventing or mimising post-traumatic complications may be hampered by our inability to target high risk patients early after injury. The purpose of this study was to derive a guideline for the prediction of posttraumatic organ failure using cell free (plasma) DNA and other predictors of post-traumatic complications. Methods—The research ethics committee approved a prospective, observational study investigating molecular responses of patients to injury. Plasma DNA was measured using a real time, quantitative, polymerase chain reaction assay for the â globin gene in 84 patients (mean age 38 (SD 16) years; 83% male) triaged to an emergency department resuscitation room within a median time of 60 minutes (interquartile range 50, 90; range 30–240) from injury. Other variables were injury severity scores, white cell count (WCC) and shock index (SI). Organ failure (OF) and multiple organ dysfunction syndrome (MODS) occurred in 21 of 84 (25%) and 9 of 84 (11%) cases respectively. After univariate and receiver operator curve analysis, data were further analysed using a classification and regression tree. Results—Within four hours of injury, OF could be correctly predicted (predictive value positive, PV+) in 85.7% cases (n = 18 of 21; 95%CI 62.6% to 96.2%) by: (1) cell free DNA > 140 000 genome equivalents/ml, (2) injury severity score (ISS) > 27 and (3) WCC > 13.4 (×10/l). OF could be correctly excluded (predictive value negative, PV−) in 95.2% cases (n = 60 of 63; 95%CI 85.8% to 98.8%) by (1) cell free DNA < 141 000 genome equivalents/ml, (2) ISS < 27 and (3) WCC < 13.4. Sensitivity and specificity were 85.7% (95%CI, 62.6% to 96.2%) and 95.2% (95% CI, 85.8% to 98.8%) respectively. MODS could be correctly predicted (PV+) in 87.5% cases (n = 7 of 8; 95%CI 46.7% to 99.3%) by: (1) cell free DNA > 108 000 copies/ml, (2) maximal abbreviated injury score (MAIS) > 3, and (3) SI > 0.72. MODS could be correctly excluded (PV−) in 97.3% cases (n = 71 of 73; 95%CI 89.6% to 99.5%) by (1) cell free DNA < 108 000 copies/ml, (2) MAIS < 3.0 and (3) SI < 0.72. Sensitivity and specificity were 77.8% (95%CI, 40.2% to 96.1%) and 98.6% (95% CI, 91.5% to 99.9%) respectively. Conclusion—Plasma DNA analysis allows the development of early accurate guidelines for the prediction of post-traumatic OF and MODS. These guidelines now require prospective validation. The eVects of in vivo haemodilution with 0.9% sodium chloride and Gelofusine on whole bloo","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64231410","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":"Emergency Medicine, Concepts and Clinical Practice. 4th Edition on CD-ROM.","authors":"G. Johnson","doi":"10.1136/emj.17.6.432-b","DOIUrl":"https://doi.org/10.1136/emj.17.6.432-b","url":null,"abstract":"Rosen's Emergency Medicine is the gold standard against which other textbooks in our specialty are compared. The current weighty and authoritative three volume, 3000 page text is now available as a single CD-ROM. The disk also contains three other Mosby products supplying prescribing information, drug interaction data, and patient handouts for prescribed drugs. These, however, will be of little interest to a UK audience.\u0000\u0000Most readers will be familiar with the excellence of the content and comprehensive coverage provided by the printed text. …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.432-b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64231664","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":"A national census of ambulance response times to emergency calls in Ireland.","authors":"N Breen,&nbsp;J Woods,&nbsp;G Bury,&nbsp;A W Murphy,&nbsp;H Brazier","doi":"10.1136/emj.17.6.392","DOIUrl":"https://doi.org/10.1136/emj.17.6.392","url":null,"abstract":"<p><strong>Background: </strong>Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision.</p><p><strong>Methods: </strong>A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results-2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5-33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10-47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0-10%). Median patient care times for \"on call\" crews were three times longer than \"on duty\" crews.</p><p><strong>Conclusion: </strong>Without prioritized use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927745","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. Elastic compression stockings and the risk of post-thrombotic syndrome in patients with symptomatic proximal vein thrombosis.","authors":"B Lane,&nbsp;S Jones","doi":"10.1136/emj.17.6.405","DOIUrl":"https://doi.org/10.1136/emj.17.6.405","url":null,"abstract":"Report by Beverley Lane, Research Nurse Search checked by Steve Jones, Research Fellow \u0000\u0000A 35 year old woman attends the emergency department with a swollen and painful left leg. A DVT is suspected and confirmed on ultrasound. You are aware of the possible risks of developing post-thrombotic …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927751","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":"Brugada syndrome--the missed epidemic.","authors":"J M Butler","doi":"10.1136/emj.17.6.426","DOIUrl":"https://doi.org/10.1136/emj.17.6.426","url":null,"abstract":"<p><p>About 10-20% of patients dying suddenly or resuscitated from ventricular fibrillation do not have demonstrable heart disease. These people are often young and tragically in some cases sudden death is the first and only clinical event. One of the three main electrophysiological diagnoses to be considered in these situations is the Brugada syndrome. A case of Brugada syndrome is described, together with an example of the classic electrocardiographic manifestations and a discussion of the possible aetiology, diagnosis and management of this condition.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927758","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":"Posterior dislocation of hip in adolescents attributable to casual rugby.","authors":"K Mohanty,&nbsp;S K Gupta,&nbsp;A Langston","doi":"10.1136/emj.17.6.429","DOIUrl":"https://doi.org/10.1136/emj.17.6.429","url":null,"abstract":"A 17 year old boy was assaulted with a skateboard, from which he sustained a laceration to his forehead and below his left eye. His wounds were closed primarily in accident and emergency and he was given a course of oral flucloxacillin. He returned to the department two days later having become increasingly unwell with lethargy, fever, and marked swelling with tenderness over the left lower eyelid.\u0000\u0000On examination he had a tachycardia of 120 and a pyrexia of 38.9. He had mild chemosis of the left eye with a …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927759","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":"Does intraosseous have to mean intramedullary?","authors":"G McCarthy,&nbsp;P Buss","doi":"10.1136/emj.17.6.432-a","DOIUrl":"https://doi.org/10.1136/emj.17.6.432-a","url":null,"abstract":"Editor,—Further to Foex's historical note on the intraosseous route for fluid administration1 and Lavis's recommendations regarding its use in extreme circumstances in adults,2 we would like to mention our previously reported experience where use of an intracalcaneal infusion proved very successful in the resuscitation of a seriously ill child.3 In our opinion, this case questions the assumption that it is necessary to have a functioning medullary cavity in the bone where an intraosseous needle is used. Could it just be that a bone …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.432-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21928931","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":"Acute medicine: the physician's role. A working party report of the Federation of Royal Colleges of Physicians of the United Kingdom.","authors":"R D Hardern","doi":"10.1136/emj.17.6.391","DOIUrl":"https://doi.org/10.1136/emj.17.6.391","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927744","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. SimpliRed D-dimer assay in suspected pulmonary embolus.","authors":"M Harrison,&nbsp;S Jones","doi":"10.1136/emj.17.6.404","DOIUrl":"https://doi.org/10.1136/emj.17.6.404","url":null,"abstract":"Report by Magnus Harrison, Research Fellow Search checked by Steve Jones, Research Fellow A 40 year old man presents with acute suspected pulmonary embolus (PE). You wonder whether a negative SimpliRed d-dimer assay is sufficient to rule out the diagnosis of PE. In [a patient suspected of having an acute pulmonary embolus] is [a …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.6.404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21927750","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}