Archives of emergency medicine最新文献

{"title":"Methaemoglobinaemia as a result of sodium nitrate poisoning.","authors":"J K Gosnold, G S Johnson","doi":"10.1136/emj.10.3.260","DOIUrl":"https://doi.org/10.1136/emj.10.3.260","url":null,"abstract":"Sir We report a case of methaemoglobinaemia as a result of sodium nitrite poisoning. Early recognition and administration of the specific antidote methylene blue may lead to complete recovery. A 39-year-old man ingested 100 ml of a liquid he believed to be beer. On arrival in our department he was deeply cyanosed and unconcious with a pulse of 140 and a blood pressure of 70 systolic. Endotracheal intubation and ventilation with 100% oxygen failed to improve the cyanosis and a clinical diagnosis of methaemoglobinaemia was made. Despite intravenous methylene blue he developed an asystolic cardiac arrest from which he could not be resuscitated. Subsequent analysis of the ingested fluid showed it to contain 33.5% sodium nitrite. Sodium nitrite is used in industry during the manufacture of dyes and synthetics and is also used in low concentrations as a meat preservative. There are reports of nitrite poisoning due to' its excessive use a meat preservative (Walley et al., 1987) or as a result of mistaking sodium nitrite for table salt (McQuiston 1936). Abuse of organic nitrites by ingestion or inhalation for their psychodelic and stimulant properties may also lead to methaemoglobinaemia (Shesser et al., 1981). Small doses of sodium nitrite may produce headache, vomiting, diarrhoea, flushing and cyanosis. Ingestion of more than 1 g of sodium nitrite leads to rapid cardiovascular collapse and death (Polson et al., 1969). Typically, samples of the patients blood are dark brown and confirmation of the diagnosis is obtained by measuring serum methaemoglobin levels. Treatment of nitrite poisoning consists of the administration of high concentrations of oxygen and methylene blue intravenously in a dose of 1-2mgkg-1 body weight. Methylene blue acts by promoting reduction of the oxidized haem iron back to its ferrous state (Polson et al., 1969). Nitrite poisoning and methaemoglobinaemia are rare, however awareness of this condition in the cyanosed patient unresponsive to oxygenation and early administration of methylene blue may be life saving. It is recommended that methylene blue is available in Accident and Emergency A&E units for use in such cases.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"260-1"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206097","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":"X-rays as a diagnostic aid in winged scapula.","authors":"A Banerjee","doi":"10.1136/emj.10.3.261-b","DOIUrl":"https://doi.org/10.1136/emj.10.3.261-b","url":null,"abstract":"McQuiston T. A. C. (1936) Poisoning with sodium nitrite. Lancet 2, 1153-1154. Polson C. J. & Tattersall R. N. (1969) Clinical Toxicology 2nd Ed, pp. 109-116. Pitman Medical, London. Shesser R., Mitchell J. & Edelstein S. (1981) Methaemoglobinaemia from isobutyl nitrite preparations. Annals of Emergency Medicine 10, 262-264. Walley T. & Flanagan M. (1987) Nitrite induced methaemoglobinaemia. Postgraduate Medical Journal 63, 643-644.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"261-3"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.261-b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206099","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 important complication of upper cervical spine fracture: a case report.","authors":"D W Hodgkinson,&nbsp;D J Bamford,&nbsp;P Driscoll","doi":"10.1136/emj.10.3.235","DOIUrl":"https://doi.org/10.1136/emj.10.3.235","url":null,"abstract":"<p><p>A case report is presented of a patient who sustained a high cervical spine fracture, the possible mechanisms of injury and details of the fracture are discussed. The patient developed bilateral vagal nerve palsies 48 h after the accident. This complication was only recognized after dysphagia and an aspiration pneumonia developed. The complication of aspiration pneumonia was preventable. Meticulous and repeated examination of the cranial nerve function in this type of injury is recommended. Normal feeding should commence only when the cranial nerve function has been shown to be normal after repeated examination.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"235-8"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206094","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 conservative treatment of mallet finger with a simple splint: a case report.","authors":"A Maitra,&nbsp;B Dorani","doi":"10.1136/emj.10.3.244","DOIUrl":"https://doi.org/10.1136/emj.10.3.244","url":null,"abstract":"<p><p>Sixty patients with mallet finger deformity were randomly treated with either a Stack or a custom-made padded aluminium alloy malleable finger splint. Both splints were equally effective in correcting the deformity but the aluminium alloy splint was able to be fitted to a wider variety of finger shapes and sizes and caused significantly fewer skin complications.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"244-8"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206096","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":"Critical care by emergency physicians in American and English hospitals.","authors":"L G Graff,&nbsp;S Clark,&nbsp;M J Radford","doi":"10.1136/emj.10.3.145","DOIUrl":"https://doi.org/10.1136/emj.10.3.145","url":null,"abstract":"<p><p>The object of this study was to compare emergency physician critical care services in an American (A) and an English (E) Emergency Department (ED). A prospective case comparison trial was used. The study was carried out at two university affiliated community hospitals, one in the U.S.A and one in England. Subjects were consecutive patients triaged as requiring critical care services and subsequently admitted to the hospital ward (A, n = 17; E, n = 18) or the intensive/critical care unit ([ICU] A, n = 14; E, n = 24). The study time period was randomly selected 8-h shifts occurring over a 4-week period. All patients were treated by standard guidelines for critical care services at the study hospital emergency department. For all study patients mean length of stay was significantly longer for the American (233 min, 95% CI 201, 264) than the English ED (24 min, 95% CI 23, 25). American emergency physicians spent less total time providing physician services (19.2 min, 95% CI 16.8, 21.6) vs. (23 min, 95% CI 21.6, 24.4) than English emergency physicians. American emergency physicians spent less time with the patient than English emergency physicians: 12.4 min (95% CI 10.3, 14.5) vs. 17 min (95% CI 15.8, 18.2). American emergency physicians spent more time on the telephone 1.8 min (95% CI 1.4, 2.2) vs. 1.2 min (95% CI 1.1, 1.3), and in patient care discussions/order giving 1.8 min (95% CI 1.4, 2.2) vs. 1.1 min (95% CI .8, 1.4), There was no significant difference in time charting (3.2 min, 95% CI 2.8, 3.6 vs. 3.5 min, 95% CI 3.2, 3.8). Results did not vary significantly whether analysed subgroups or the whole study group. American emergency physicians provided 81% of their service during the first hour. There were delays at the American hospital until the physician saw the patient: 4.9 min (95% CI 2.5, 7.3) for patients admitted to the ICU/CVU (Cardiovascular Unit), and 9.2 min (95% CI 4.6, 13.8) for patients admitted to the ward. At the American hospital, ICU/CVU physicians provided additional physician services in the emergency department whether the patient was admitted to the ward (6.7 min, 95% CI 5.5, 7.9) or the ICU/CVU (12.1 min, 95% CI 8.8, 15.9). For patients admitted to the ICU/CVU 47% of the length of stay was spent waiting for a bed to become available after the decision to admit had been made. Emergency physicians at E provided critical care services almost continuously during a short stay in the ED. Emergency physicians at A provided services intermittently with most services during an initial period of stabilization. Further study is necessary to identify what factors contribute to these different approaches to critical care in the ED.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"145-54"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206248","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":"Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period.","authors":"N J Fothergill,&nbsp;M T Hunt,&nbsp;R Touquet","doi":"10.1136/emj.10.3.155","DOIUrl":"https://doi.org/10.1136/emj.10.3.155","url":null,"abstract":"<p><p>The results of a 6-month retrospective audit of patients presenting with chest pain to an accident and emergency (A&E) department to which 46,000 new patients per year present are discussed. The computer diagnostic code assigned to the patients by the A&E doctor, referral rates for second opinion and disposal after assessment in the A&E department are examined, with particular reference to patients who may have had serious cardiac pathology, such as acute myocardial infarction (AMI) or unstable angina. Audit showed that overall 61% of patients with chest pain of all causes were assessed and discharged home by A&E doctors without recourse to second opinion. Of patients thought by the A&E doctors to have chest pain of cardiac origin, who were referred to the duty medical registrar or cardiologist, 88% were admitted. As a result of these findings a policy of more open referral for second opinion was instituted to reduce the likelihood of discharging patients home with serious cardiac pathology. In addition, the clinical problems of AMI and unstable angina are emphasized to all senior house officers early in their educational programme after joining A&E. Published literature on the diagnosis and misdiagnosis of AMI and unstable angina in the A&E department is reviewed. These studies are almost exclusively from North America, and a need for similar work in the U.K. is discussed.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"155-60"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206864","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 audit of care received by patients injured during sporting activities.","authors":"S Grimble,&nbsp;I G Kendall,&nbsp;M J Allen","doi":"10.1136/emj.10.3.203","DOIUrl":"https://doi.org/10.1136/emj.10.3.203","url":null,"abstract":"<p><p>A summary of injuries sustained by 340 sportsmen over 9 successive weekends from 16 November 1991 to 12 January 1992 attending an accident and emergency (A&E) department is presented. Most injuries occurred in young males usually as a result of soccer or rugby. Sixty-seven per cent of patients were discharged with no further followed up in hospital. Seventy-two per cent of patients were X-rayed, 33% of X-rays showed a fracture or dislocation. A total of 193 attendees received minimal treatment, (defined as discharge with advice only, simple analgesia or strapping only with no hospital follow-up) and of these 152 were X-rayed. A total of 100 patients who received minimal treatment were selected randomly by computer to receive a follow-up letter asking about certain issues relating to their care in the A&E department. Most patients felt that the A&E Department was the most appropriate source of treatment for their sports injury, and over half attended specifically for an X-ray examination. Despite the doctors view that many of these minor injuries could have been self-treated, few patients felt able to treat future similar minor injuries themselves. They were, however, more likely to go elsewhere for treatment on subsequent occasions.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"203-8"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206873","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":"Practical Fracture Treatment (2nd Edition)","authors":"M. Waters","doi":"10.1136/emj.10.3.259","DOIUrl":"https://doi.org/10.1136/emj.10.3.259","url":null,"abstract":"incident involving toxic chemicals. The long table of health hazard summaries for industrial and occupational chemicals may well be useful under such circumstances, as may the list of suspected human carcinogens. These have less relevance for the practising Accident and Emergency (A&E) physician but this section is brief and worth keeping within the clinical manual as a reference source. The only small disappointment was that a book described as the 'Intemational Edition' should detail lists of poisons centres and methods of labelling toxic compounds during transport, relating only to the United States. However, despite that, it is an extremely useful and easily read, well set out source of information that should be in every A&E department and probably in the pocket of anyone involved in the emergency management of a poisoned patient.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"259 - 259"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64221611","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":"Intraperitoneal bladder rupture and the wearing of rear seat-belts--a case report.","authors":"A Stoddart","doi":"10.1136/emj.10.3.229","DOIUrl":"https://doi.org/10.1136/emj.10.3.229","url":null,"abstract":"A case is reported of intraperitoneal bladder rupture which was seen 90 min post-injury and which was associated with a significant rise in serum urea and creatinine.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"229-31"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206092","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":"Bilateral pneumothoraces.","authors":"M Sedgwick","doi":"10.1136/emj.10.3.263","DOIUrl":"https://doi.org/10.1136/emj.10.3.263","url":null,"abstract":"authors state that bony causes produced static winging which is present at rest and may be accentuated by certain passive shoulder movements. Cooley & Torg (1982) described what they termed 'pseudowinging' of the scapula produced by subscapular osteochondroma. They stressed that although subtle points of differentiation might allow the diagnosis to be suspected, the condition was liable to be confused with classical winging produced by serratus anterior paralysis. Indeed, in the case described, the latter diagnosis had initially been made by two specialists and spontaneous resolution predicted. In the case described above, radiology alone led to the correct diagnosis. The possibly misleading acute onset of symptoms was suggestive of a neurological cause. Also the winging was dynamic in that it was more prominent on asking the patient to push against a wall with both outstretched arms. A plea is made for considering X-rays as part of the basic assessment of the apparently winged scapula.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 3","pages":"263-4"},"PeriodicalIF":0.0,"publicationDate":"1993-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.3.263","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19206100","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}