F Aitchison, A Bleetman, P Munro, D McCarter, A W Reid
{"title":"Detection of pneumothorax by accident and emergency officers and radiologists on single chest films.","authors":"F Aitchison, A Bleetman, P Munro, D McCarter, A W Reid","doi":"10.1136/emj.10.4.343","DOIUrl":"https://doi.org/10.1136/emj.10.4.343","url":null,"abstract":"<p><p>To assess whether an accurate diagnosis of pneumothorax can be made on a single chest film, 233 pairs of inspiratory (I) and expiratory (E) chest films taken in an accident and emergency (A&E) department for suspected pneumothorax were reviewed by two A&E officers and three radiologists. The films were assessed for the presence of pneumothorax by viewing the I film in isolation and, after an interval, by viewing the paired I and E films together. Fifty-four of the patients had a pneumothorax. The five observers missed 23 pneumothoraces (8.5% of total) on the I film alone which were correctly diagnosed on the paired I and E films, the three radiologists missed 10/162 pneumothoraces on the I film alone which were correctly identified on the I and E films (6%) and the two A&E officers 13/108 (12.5%). The use of a single inspiratory chest film for suspected pneumothorax could result in pneumothoraces being missed, particularly by less experienced observers and therefore we believe that paired I and E films should continue to be used routinely for suspected pneumothorax.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"343-6"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102944","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 role of calcium in intravenous fluid therapy.","authors":"A D Cumming","doi":"10.1136/emj.10.4.265","DOIUrl":"https://doi.org/10.1136/emj.10.4.265","url":null,"abstract":"In general, the maintenance of calcium balance is an accepted part by the fluid and electrolyte management of patients. In the medium to long term, there are clear adverse effects of consistent negative or positive calcium balance, and both hypoand hypercalcaemia are associated with morbidity (Agus & Goldfarb, 1985). In these circumstances, monitoring of the plasma calcium concentration, and judicious use of intravenous or oral supplements, together with vitamin D analogues if required (as in renal failure), is appropriate. However, the short-term use of intravenous calcium supplementation in acutely ill patients remains a topic of controversy. For many years, the administration of intravenous calcium was a routine part of the resuscitation regime for traumatic, haemorrhagic, or cardiogenic shock. This was based on the high incidence of acute hypocalcaemia in these conditions, and the observed beneficial effects of calcium on systemic haemodynamics (Denis et al., 1985). A number of the fluid preparations available for acute intravenous use contain supplemental calcium, including crystalloids (e.g. Ringer's solution, 2.2 mmol 1I calcium) and colloids (e.g. Haemaccel, 6.25 mmol I1 calcium; Hoechst UK Ltd, Middlesex, UK). However, the use of intravenous calcium in these situation has been questioned, largely on the basis of the known increase in intracellular calcium concentration which occurs during ischaemic cellular injury (Trunkey et al., 1976).","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"265-70"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102257","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":"Reduction of anterior dislocation of the shoulder.","authors":"M Sedgwick","doi":"10.1136/emj.10.4.381","DOIUrl":"https://doi.org/10.1136/emj.10.4.381","url":null,"abstract":"","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"381-2"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102859","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":"Portable CO2 detectors.","authors":"J M Hopper, K M Porter","doi":"10.1136/emj.10.4.382-a","DOIUrl":"https://doi.org/10.1136/emj.10.4.382-a","url":null,"abstract":"","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"382"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.382-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102860","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":"Labelling of equipment dispensers.","authors":"D C Gray","doi":"10.1136/emj.10.4.365","DOIUrl":"https://doi.org/10.1136/emj.10.4.365","url":null,"abstract":"<p><p>A new labelling system for use on medical equipment dispensers is tested. This system uses one of the objects stored in each unit of the dispenser as the 'label', by attaching it to the front of the dispenser with tape. The new system was compared to conventional written labelling by timing subjects asked to select items from two dispensers. The new system was 27% quicker than the conventional system.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"365-7"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102949","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":"Calcific tendinitis of flexor carpi ulnaris: an easy misdiagnosis.","authors":"W G Ryan","doi":"10.1136/emj.10.4.321","DOIUrl":"https://doi.org/10.1136/emj.10.4.321","url":null,"abstract":"<p><p>Calcific tendinitis in the wrist is rare, and frequently misdiagnosed. A case is described and discussed with a review of the literature.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 4","pages":"321-3"},"PeriodicalIF":0.0,"publicationDate":"1993-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.4.321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19102938","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 gentle sex? Assaults on women by women.","authors":"P Burdett-Smith, I Adams","doi":"10.1136/emj.10.3.167","DOIUrl":"https://doi.org/10.1136/emj.10.3.167","url":null,"abstract":"Assaults on women have been the subject of many studies. (Gayford, 1979; Steinmetz, 1980; Knopp, 1984; Tanne, 1992). The concept of the 'battered wife' is widely accepted (Gayford, 1979). Organizations exist to offer help, counselling and places of safety to victims. However, recent Chief Constables' reports have highlighted an increase in the number of violent crimes perpetrated by women. Therefore, a study was instigated to assess all female victims of assault that attended the Accident and Emergency Department (A&E) of St James' Hospital, to ascertain if violence to women, by women, is a significant problem.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"167-71"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206866","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 need for better pre-hospital analgesia.","authors":"J A Chambers, H R Guly","doi":"10.1136/emj.10.3.187","DOIUrl":"https://doi.org/10.1136/emj.10.3.187","url":null,"abstract":"<p><p>Many patients arrive at the accident and emergency (A&E) department in pain. To quantify this problem a retrospective analysis was performed of the clinical records of 502 consecutive patients arriving by ambulance at the A&E department over a 20-day period. A total of 273 (54%) of the patients had pain as a symptom on arrival and 69 (14%) were given opioid analgesia in the A&E department. Sixty of those given opioids had a single limb fracture. A survey of all ambulance services in the U.K. was conducted by means of a postal questionnaire sent to chief ambulance officers. Only five out of 65 services give any analgesia other than Entonox (B.O.C.). There were wide variations in the attitudes of services around the country to future developments. The authors suggest that paramedics should be trained to administer intravenous opioid analgesia.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"187-92"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206870","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 injured motor cycle messenger.","authors":"D I Sweetnam, F Morris, A Cope","doi":"10.1136/emj.10.3.193","DOIUrl":"https://doi.org/10.1136/emj.10.3.193","url":null,"abstract":"<p><p>Injured motor cycle messengers make up a small but significant proportion of the young injured attending Central London accident and emergency (A&E) departments. The study confirms that the pattern of their injuries is similar to other injured urban motor cyclists, and discusses the background of the injured, in terms of experience and training, highlighting the frequency of injury and possible predisposing factors. A total of 116 injured motor cycle messengers attending two Central London A&E departments over a 10-month period were studied. Thirteen per cent sustained sufficiently serious injuries to necessitate admission, the rest were treated as out-patients for lesser injuries. The mean age was 23. Only 18% had received any formal training and 31% were in possession of a provisional driving license only. Fifty-eight per cent had been employed as a messenger for less than 3 months, yet two-thirds of them had sustained a previous injury whilst a messenger. The apparent absence of supervision of this potentially dangerous occupation is emphasized. In view of the repeated injuries sustained by many of these vulnerable young men, it is suggested that those responsible for their treatment might, in addition to their therapeutic role, give suitable guidance that might prevent re-attendance with further injuries.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"193-6"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206871","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":"Skull X-ray after head injury: the recommendations of the Royal College of Surgeons Working Party report in practice.","authors":"R E MacLaren, H I Ghoorahoo, N G Kirby","doi":"10.1136/emj.10.3.138","DOIUrl":"https://doi.org/10.1136/emj.10.3.138","url":null,"abstract":"<p><p>In 1986 a Royal College of Surgeons Working Party published guidelines, based on over 15 years of clinical research both here and in the U.S.A., on when to perform skull X-rays on a head injury patient. In this retrospective study the recorded details of 405 patients who presented to an accident and emergency (A&E) department over a 3-month period in 1991 are analysed, and the Report criteria applied to each one to assess whether the guidelines are being followed in performing a skull X-ray. According to these guidelines, 191 of these patients (47.2%) should have been X-rayed, however, only 83 were. Only one patient was thought to have been X-rayed inappropriately. The Report criteria most commonly thought by the A&E doctors not to warrant skull X-ray, were loss of consciousness, amnesia, dizziness, blurred vision, headache, and alcohol intoxication. The reasons why these criteria are being ignored are examined, and together with reference to recent studies, slight alterations to the Working Party guidelines are suggested to make them more applicable to everyday situations of head injury encountered in a casualty department.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"138-44"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206247","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}
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