Archives of emergency medicine最新文献

{"title":"Correlates of work-related stress among consultants and senior registrars in accident and emergency medicine.","authors":"J Heyworth,&nbsp;T W Whitley,&nbsp;E J Allison,&nbsp;D A Revicki","doi":"10.1136/emj.10.4.271","DOIUrl":"https://doi.org/10.1136/emj.10.4.271","url":null,"abstract":"<p><p>A mail survey was conducted of consultants and senior registrars practising accident and emergency (A&E) medicine in the United Kingdom. The 201 respondents (72%) comprised 154 consultants (70.6%) and 47 senior registrars (77%), who provided demographic information and completed inventories measuring stress, depression, task and role clarity, work group functioning and overall satisfaction with work. The respondents did not report particularly high levels of stress or depression and generally evaluated aspects of their work environments favourably. Higher levels of stress were reported by consultants and respondents from district general hospitals. Levels of stress were similar to those reported by other groups of health care providers. Respondents generally considered tasks and roles to be clearly defined, work groups to be supportive, efficient units and work satisfying. There was no statistically significant correlation on the affective scales for the number of patient attendances, on call commitment or staffing numbers. Senior staff with more than 10 years experience in the specialty reported more satisfaction with work and work group functioning, and perceived their tasks and roles to be significantly clearer. Consultants over 45 evaluated their work groups favourably and were more likely to view them as cohesive, smoothly functioning units than senior registrars. The results probably reflect the ad hoc coping strategies adopted by a group of doctors, who have already demonstrated appropriate personality characteristics by completing a long training programme, with no realistic alternative late career opportunities. To prevent mid or late career attrition, however, A&E doctors should receive formal training in stress recognition and avoidance. Accessible counselling without stigma should be easily available. Senior A&E doctors have a role in detecting and managing stress amongst other staff in the department.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"271-8"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102258","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":"Hospital hoppers--jumping to conclusion?","authors":"M V Prescott","doi":"10.1136/emj.10.4.362","DOIUrl":"https://doi.org/10.1136/emj.10.4.362","url":null,"abstract":"In 1951 Asher applied the term 'Munchausen's syndrome' to a group of patients admitted with an apparent acute illness supported by a plausible and dramatic history which was found subsequently to be made up largely of falsehoods. The patients were found to have attended and deceived an astounding number of hospitals and discharged themselves against advice, often after quarrelling with nursing and medical staff. One illustrative case history documented 18 different hospital admissions. Asher commented at the time that 'the patients gained nothing but the discomfort of the investigations and often operations. The patients appeared to have an intense desire to deceive everybody as much as possible'. However Asher did suggest in the same article that the patient's motive for the deception may be a desire to be the centre of interest and attention (Walter Mitty syndrome) if not being the surgeon they could still gain from the equally dramatic role of being the patient! Munchausen's syndrome is used synonymously with chronic factitious illness (American Psychiatric Association, 1987). It is suggested (Pankratz, 1981; Ford, 1986) that besides factitious illness the patient should fulfil the two other main characteristics in Asher's description peregrination and pseudologica fantastica to be diagnosed as Munchausen's syndrome. The very name has been criticized (Patterson, 1985) and others have been suggested: 'Hospital Hoboes', 'Hospital Vagrants', 'the desire to be ill' (Parker & Barrett, 1991). In the West Midlands these patients are termed 'Hospital Hoppers'. The syndrome has been extended to take in a particular form of child abuse Munchausen's syndrome by proxy (Meadow, 1977). Patients continue to deceive and doctors continue to write about it. It has been suggested (Markantonakis & Lee, 1988) that a central register of known sufferers be established by the Royal College of Psychiatrists. Many of these patients present to accident and emergency (A&E) departments in an attempt to gain admission to hospital. Many are identified by experienced staff, often it seems, without reference to any file. Within the West Midlands Health Authority an informal system of notification of other hospitals has become established. A&E departments receive occasional letters giving some patient details and history relating to previous attendance(s) but there is not, it would seem, an organized system of identification or notification of these cases.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"362-4"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102948","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":"Fractures of the terminal phalanx presenting as a paronychia.","authors":"H R Guly","doi":"10.1136/emj.10.4.301","DOIUrl":"https://doi.org/10.1136/emj.10.4.301","url":null,"abstract":"<p><p>Three fractures at the base of the terminal phalanx of the finger and one at the base of the terminal phalanx of the tow were initially misdiagnosed as paronychias. If a 'paronychia' follows trauma, the possibility of a fracture should be considered and radiographs taken of the digit.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"301-5"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102934","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":"Mixed-sex wards: a survey of patient's opinions.","authors":"D S Hadden,&nbsp;C H Dearden,&nbsp;G Ross","doi":"10.1136/emj.10.4.354","DOIUrl":"https://doi.org/10.1136/emj.10.4.354","url":null,"abstract":"","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"354-6"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102946","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":"Chemical burns causing systemic toxicity.","authors":"M W Cooke,&nbsp;R E Ferner","doi":"10.1136/emj.10.4.368","DOIUrl":"https://doi.org/10.1136/emj.10.4.368","url":null,"abstract":"Chemical burns can cause severe local pain and tissue damage which require specialized treatment. They account for one patient in six admitted to a bums unit after an industrial accident (Herbert & Lawrence, 1989). Strong acids and alkalis are the commonest cause. The initial treatment of nearly all such burns is to drench the affected area with water, remove contaminated clothing and continue dre-nching. There is however a theoretical danger of explosion if water is used to remove certain alkali metals (sodium, potassium, rubidium and caesium) because they liberate hydrogen gas and heat. Strong acids and alkalis also evolve heat when water is added, but the heat is dissipated rapidly if sufficient water is used. The local effects of chemical tissue destruction can be very severe and may distract attention from the dangers of systemic toxicity, which are greatest for burns due to yellow (white) phosphorus, hydrofluoric acid and phenols. Yellow phosphorus is an important intermediate in the production of phosphorus pentoxide, phosphoric acid and phosphorus chloride and sulphide. It is also used in tracer bullets. It ignites in air to produce the acid gas phosphorus pentoxide. Wounds should therefore be drenched and then left immersed in water or covered with wet dressings. The phosphorus particles can be removed with forceps and stored under water. They are easier to see if washed or swabbed with a 1% copper sulphate solution, when black copper sulphide is formed, followed by 1% sodium bicarbonate solution to neutralize any phosphoric acid. Only dilute copper sulphate solution should be used, to avoid systemic absorption of copper ions, which may result in haemolysis (Summerlin et","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"368-71"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102950","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":"Computer-assisted diagnosis and abdominal pain.","authors":"A K Maitra","doi":"10.1136/emj.10.4.384","DOIUrl":"https://doi.org/10.1136/emj.10.4.384","url":null,"abstract":"management prior to transfer was a Glasgow Coma Score of less than 8, as in such unconscious patients airway obstruction may be insidious and unrecognized. In addition, there was a requirement for a guaranteed supply of 100% oxygen (Meredith & Vale, 1988) and a necessity to lower suspected elevation of intracranial pressure by hyperventilation. These needs would have been met by intubation and ventilation. We perform approximately 300 critical care transfers per annum, both by rotary and fixed wing aircraft. We endotracheally intubate 80% of patients to ensure optimum oxygenation and ventilation and would not contemplate transferring an unconscious CO poisoned patient without first protecting the airway in this fashion. Until appropriate patients are accorded this most fundamental intervention, there will continue to be avoidable morbidity and mortality in inter-hospital transfers.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"384-5"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102863","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":"Consultant triage of minor cases in an accident and emergency department.","authors":"A D Redmond,&nbsp;N Buxton","doi":"10.1136/emj.10.4.328","DOIUrl":"https://doi.org/10.1136/emj.10.4.328","url":null,"abstract":"There is no doubt that many patients who attend accident and emergency (A&E) departments have minor conditions which do not always merit immediate hospital treatment and could be treated by a general practitioner (GP) (Davison et al., 1983; Cliff & Wood, 1986). Such patients are termed 'inappropriate attenders', as they are not considered emergencies by the staff of the A&E department and may not have had an accident. The time and resources required to deal with these conditions may be taken from that allocated to more serious or 'appropriate' cases. Attempts to re-educate those who have waited several hours are unlikely to be successful. Most attempts at dealing with the problem are based on nurse triage (Parmar & Hewitt, 1985; Bailey et al., 1987). On arrival in the department, patients","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"328-30"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102940","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 value of radiographs in the management of the fractured nose.","authors":"A Nigam,&nbsp;A Goni,&nbsp;A Benjamin,&nbsp;A R Dasgupta","doi":"10.1136/emj.10.4.293","DOIUrl":"https://doi.org/10.1136/emj.10.4.293","url":null,"abstract":"<p><p>Over a 6-month period a record was kept of all patients presenting to the accident and emergency (A&E) department with nasal injuries. The results of the nasal radiographs were analysed to gauge their benefit. It was found that there was poor correlation between the radiological findings and the presence of external deformity, the latter determining the decision to carry out treatment. Routine radiographs of the nose are unnecessary in patients with nasal trauma.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"293-7"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102261","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":"Intracranial haemorrhage associated with ingestion of 'ecstasy'.","authors":"J C Hughes,&nbsp;M McCabe,&nbsp;R J Evans","doi":"10.1136/emj.10.4.372","DOIUrl":"https://doi.org/10.1136/emj.10.4.372","url":null,"abstract":"<p><p>A case of a patient with intracranial haemorrhage thought to have been associated with ingestion of 'Ecstasy' [3-4 methylenedioxymethamphetamine (MDMA)] is presented. The case illustrates the importance of drug analysis in cases involving illicit drug use.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"372-4"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18904847","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 spinal epidural haematoma: a cautionary tale.","authors":"G M Lord,&nbsp;N Mendoza","doi":"10.1136/emj.10.4.339","DOIUrl":"https://doi.org/10.1136/emj.10.4.339","url":null,"abstract":"<p><p>Less than two hundred cases of spontaneous spinal epidural haematoma (SSEH) have been reported in the literature and theories as to its genesis are diverse. It is a serious condition, especially if there is a delay in diagnosis, as early treatment confers marked prognostic advantage. We present a case report of a 68-year-old male who was diagnosed as having a spinal epidural haematoma, followed by a discussion of the possible aetiology of this condition.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"339-42"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102943","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}