Archives of emergency medicine最新文献

{"title":"Trauma, inflammatory cells and ARDS.","authors":"S C Donnelly, C Robertson","doi":"10.1136/emj.10.2.108","DOIUrl":"https://doi.org/10.1136/emj.10.2.108","url":null,"abstract":"The adult respiratory distress syndrome (ARDS) was initially described by Ashbaugh as comprising profound hypoxia refractory to oxygen therapy, loss of lung compliance and diffuse radiographic alveolar infiltration (Ashbaugh et al., 1967). The pathophysiological features of ARDS are well established and include reduced functional residual capacity and lung compliance, increased airway resistance, microvascular permeability and severe ventilation/perfusion mismatch (Petty & Fowler 1982; Lloyd et al., 1984; Repine et al., 1992). It is now considered that the process is initiated by a provoking combination of insults, most often distant to the lung, which results in mediator release. This, in turn, initiates a complex sequence of cellular events culminating in breakdown of alveolar/capillary integrity in the lung, leakage of protein-rich fluid into the airspaces, and the clinical manifestations as outlined above.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"108-11"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315301","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":"Violence at work.","authors":"V Schnieden","doi":"10.1136/emj.10.2.79","DOIUrl":"https://doi.org/10.1136/emj.10.2.79","url":null,"abstract":"Violence appears to be increasing within our society along with a disregard for property as illustrated by the recent incidents on estates in Britain. The definition of violence varies and may include deliberate self-harm (DSH), damage to property, verbal abuse, threatening behaviour and physical attacks on persons or on staff (Shader et al., 1977; Fottrell, 1980; Ruben et al., 1980; Bouras et al., 1982; Dietz & Rada, 1982; Tardiff, 1983; Aiken, 1984; Hodkinson et al., 1985; Werner & Bouras, 1988). It has been recognized that Health Care Workers are at risk of violence in their working environment (Health Services Advisory Committee, 1987; DHSS Advisory Committee on violence to staff 1988; Harrington, 1990). A recent report by the National Union of Public Employees (1991) showed that 87% of those respondents to a questionnaire were worried about violence in their work, i.e. in a hospital setting. Few (43%) of the hospitals had a policy on violence, only 3% of hospitals offer special training to all staff and up to 50% give no training. Only 25% of the hospitals had advised staff on the procedure to report incidents. Much of the chronic under-reporting was of verbal abuse or threats. Under-reporting of assaults has been noted in previous studies (Lion et al., 1981; Conn & Lion, 1983). A review by the author of incident forms in the Accident and Emergency Department of University College, London confirmed under-reporting of such events. Staff reported serious physical attacks or incidents relating to possible medical consequences in this case exposure to blue asbestos; but not verbal abuse. Other studies also show serious incidents being reported (Wenk et al., 1972; Infantino & Mustingo, 1985). Explanations that have been offered for under-reporting include the fact that the frequency is so high that it is not reported; that report filling is tiresome and staff see no change as a result of it and; staff fear serious accusations of negligence and inadequate performance (Conn & Lion, 1983; Lion et al., 1983). Doctors on call for psychiatry at University College Hospital Accident and Emergency Department had not filled in incident forms although there had been","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"79-85"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.79","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315308","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":"Epidemiology of burns presenting to an accident and emergency department.","authors":"P Grout, M Horsley, R Touquet","doi":"10.1136/emj.10.2.100","DOIUrl":"https://doi.org/10.1136/emj.10.2.100","url":null,"abstract":"The survey was undertaken in order to review the circumstances surrounding accidents that precipitated burn injuries which, presented to an inner city accident department. Figures are available of the number of bums seen in Plastic Surgical units (Bumcare Symposium, 1986), and of the number of burns occurring at home (Consumer Safety Unit, 1986), however, there is no published work documenting patients with bum injuries attending an A&E department in this country, except indirectly in articles dealing with injuries to particular regions of the body, e.g. the hand (Cutting et al., 1987), or with particular causes and types of burns (Bull et al., 1964).","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"100-7"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315300","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":"A case of methaemoglobinaemia.","authors":"M J Dudley, T Solomon","doi":"10.1136/emj.10.2.117","DOIUrl":"https://doi.org/10.1136/emj.10.2.117","url":null,"abstract":"Methaemoglobinaemia is rare but should be considered in cases of cyanosis unresponsive to oxygen therapy. An example of this is given involving the accidental ingestion of Amyl Nitrite.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"117-9"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315303","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":"Successful resuscitation from sea water drowning.","authors":"P F Mahoney,&nbsp;L Williams,&nbsp;J I Andrews","doi":"10.1136/emj.10.2.120","DOIUrl":"https://doi.org/10.1136/emj.10.2.120","url":null,"abstract":"<p><p>A case of a 24-year-old male who survived a near drowning despite suboptimal pre-hospital management is reported. The case illustrates the value of continuing resuscitative efforts even in the apparently dead drowning victim.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"120-2"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315304","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 Kurdish refugee crisis--what have we learned?","authors":"A D Redmond,&nbsp;J Jones","doi":"10.1136/emj.10.2.73","DOIUrl":"https://doi.org/10.1136/emj.10.2.73","url":null,"abstract":"","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 2","pages":"73-8"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.2.73","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19315307","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":"Prospective audit of the pattern, severity and circumstances of injury sustained by vehicle occupants as a result of road traffic accidents.","authors":"A Bradbury,&nbsp;C Robertson","doi":"10.1136/emj.10.1.15","DOIUrl":"https://doi.org/10.1136/emj.10.1.15","url":null,"abstract":"<p><p>The pattern and severity of injuries sustained by 174 vehicle occupants consecutively admitted to the Accident and Emergency Department of the Edinburgh Royal Infirmary were prospectively documented. Drivers (DR) accounted for 66% of the patients, 20% were front seat passengers (FSP) and 14% were rear seat passengers (RSP). Injured patients were more likely to be male, young, intoxicated and not wearing a seat-belt. The position of the patient within the vehicle at the time of the accident and point of impact significantly affected the pattern of injury sustained. The majority of injuries were sustained by the upper body and the pattern of injury is discussed. Most accidents occurred at low speeds and higher speeds were associated with an increased severity of injury. Seat-belts reduced the overall severity of injuries, in particular those to the face and chest, but may increase the risk of neck injury. Head-rests do not appear to influence the incidence of neck injury. Clinically apparent alcohol intoxication was associated with a markedly increased risk of severe injury.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19434845","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 evaluation of a logbook for trainees in accident & emergency medicine in the United Kingdom: senior consultant opinion.","authors":"C Luke,&nbsp;E Kadzombe,&nbsp;D Gorman,&nbsp;A Armstrong","doi":"10.1136/emj.10.1.43","DOIUrl":"https://doi.org/10.1136/emj.10.1.43","url":null,"abstract":"<p><p>A previous paper from the Merseyside Group of Senior Registrars in Accident & Emergency Medicine examined the desirability of a logbook for Higher Specialist Training (HST) in accident & emergency medicine in the United Kingdom and its principal ingredients (Luke et al., 1991). A survey of 100 senior registrars and recently appointed consultants in the specialty identified the main issues of importance to the majority of respondents e.g. certification in advanced cardiac and trauma life support, a minimum of three years in the specialty before appointment as senior registrar and certain key secondments. In this paper, more senior consultants in the specialty were surveyed and a resounding majority concurred with the preferences of their junior colleagues. The findings are discussed and the implications for a future curriculum for postgraduate training in A&E medicine are explored.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"43-7"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19436780","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 S Quattro: a new system for the management of difficult intra-articular fractures of the phalanges.","authors":"S H Bostock,&nbsp;P A Nee,&nbsp;N R Fahmy","doi":"10.1136/emj.10.1.55","DOIUrl":"https://doi.org/10.1136/emj.10.1.55","url":null,"abstract":"Fractures of the phalanges of the fingers are common injuries. The average accident and emergency department will see several hundred each year (Benke & Stableforth, 1979). Causal factors include falls, road traffic accidents and commonly sport, especially football and cricket (Barton, 1977). About 18% of all phalangeal fractures extend into a joint, usually the proximal interphalangeal joint and 8% are associated with comminution (Barton, 1984). Such injuries are associated with considerable morbidity, the main problem being stiffness and deformity. Fractures involving the proximal interphalangeal joint for example often lead to dorsal subluxation of the base of the middle phalanx. Although they are stable in flexion, it is undesirable to immobilize the joint in this way as stiffness will result (James, 1970). The stiffness is a particular problem with the proximal joint whose normal range of movement exceeds that of the distal interphalangeal joint contributing considerably to the grip strength. Displaced comminuted phalangeal fractures or intra-articular fractures, especially where more than 40% of the joint surface is involved, present the greatest difficulties. Even if immobilized in extension, the finger may become stiff in extension later. Early mobilization is appropriate for minor avulsions and other stable fractures but for the more complicated injuries, a more aggressive approach","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"55-9"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.55","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19436782","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":"Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.","authors":"I A Scott,&nbsp;G J Fitzgerald","doi":"10.1136/emj.10.1.1","DOIUrl":"https://doi.org/10.1136/emj.10.1.1","url":null,"abstract":"<p><p>All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. There was an increase in survivors from 4%, prior to OH-DEFIB, to 9% of all cardiac arrests, but this was not statistically significant (P = 0.3). However, long term survival amongst immediate survivors was associated with a statistically significant improvement following the introduction of OH-DEFIB (15 of 30 (50%) vs. 2 of 19 (10.5%), P < 0.01). Mean call-out, at-scene and transfer times did not significantly vary between survivors and non-survivors. A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19434843","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}