Archives of emergency medicine最新文献_第9页

Telephoned head injury referrals: the need to improve the quality of information provided. 电话头部损伤转诊:需要提高所提供信息的质量。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.29

K A Walters

引用次数: 28

Do ambulance crews triage patients. 救护人员对病人进行分诊吗?

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.61

K Porter

{"title":"Do ambulance crews triage patients.","authors":"K Porter","doi":"10.1136/emj.10.1.61","DOIUrl":"https://doi.org/10.1136/emj.10.1.61","url":null,"abstract":"Sir I have read with interest the article on paramedic care (Rouse, 1991) and the conclusion that ambulance crews do not triage patients properly and that prehospital care by paramedics may be jeopardizing patient care. Twenty-four per cent of the patients were 'very seriously injured: they had multiple other injuries, vascular compromise, shock and amputations'. It is clear that most of the patients required an intravenous infusion as early as possible, particularly as the mean transit time to hospital was 20min. Intravenous infusion, of course, follows the primary assessment where priority must be given to airway care the maintenance of breathing and arrest of external haemorrhage. Airway care and spinal immobilization are all important time consuming factors and even if a scoop and run policy is adopted the neck must be protected and a clear airway established and maintained. It has been shown in this unit that delayed resuscitation in patients with compound fractures in isolation increases the incidence of complications particularly fat embolism, and I would advocate early oxygen therapy and intravenous infusion. Clearly there must be accepted protocols for the time it takes to set up an intravenous infusion and an analysis in the West Midlands recently of 100 trauma cases (excluding entrapment) in which intravenous infusion was part of stabilizing care revealed a mean on-scene time of 17min. Doctors with experience of pre-hospital care will appreciate the time it takes to satisfactorily stabilize a patient and I would include this time as being part of effective treatment within the 'golden hour'. For instance, a patient with a compound fractured femur needs a full assessment and treatment based on the usual priorities of care and for his fractured femur appropriate dressings, splintage and pain relief, all of which takes time and if the accident is some distance from the hospital and intravenous infusion is necessary. I have never seen a paramedic undertake these measures to the detriment of attending to the greater priorities in care, in particular, airway care, neck care, breathing and circulation and on many occasions I have received patients where minimal treatment, if any, has been given for there limb fractures because of life threatening priorities elsewhere. Based on the clinical information in this paper it would not be unreasonable to come to the conclusions that pre-hospital management by paramedics is enhancing the care as there are no data in this paper to suggest that paramedic intervention is jeopardizing patient survival. Prospective patient audit using more acceptable techniques such as TRISS (Boyd et al., 1987) need to be undertaken before prehospital management by paramedics can be fully evaluated and, in particular, before suggesting that they are jeopardizing patient care.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"61-2"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.61","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19436783","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}

引用次数: 3

Vascular Surgery; Current Questions 血管手术;当前的问题

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/EMJ.10.1.60

R. Vohra

引用次数: 0

Should wearing of cycle helmets become compulsory? 应该强制佩戴自行车头盔吗?

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.62

J Worrell

{"title":"Should wearing of cycle helmets become compulsory?","authors":"J Worrell","doi":"10.1136/emj.10.1.62","DOIUrl":"https://doi.org/10.1136/emj.10.1.62","url":null,"abstract":"Sir As a mild to moderate cyclist, (65 miles per week, mostly with a helmet!) I would like to question M. W. Cooke's suggestion that cycle helmet wearing should be compulsory. Firstly, consider accident cause. In a series of 394 cycle injuries presenting to an A&E department 63% were caused by the cyclist's inability to control the bike no vehicle or other factors were involved. We need to educate cyclists to ride properly, particularly the children. Secondly, in the above study only 26% were involved in a collision with a motor vehicle. In a separate study of head injuries to cyclists (Worrell, 1987) 38% were caused by collision with a motor vehicle, but 58% just fell off. Agreed, a collision will produce a more serious injury, but we must educate motorists to look out for cyclists, and also to enforce existing speed limits (E = 1 x 2 MV-2). Why should cyclists be compelled to protect themselves from the illegal acts of others? Thirdly, this law would be totally unenforceable, a fact recognized by a recent meeting of the House of Commons Select Committee on Transport, and surprisingly backed by the Department of Transport! Fourthly, he may not be aware that the BS for helmets is designed in such a way that the helmet must withstand an impact on an angled edge, which makes the helmet hot and heavy to wear. The 'comfort factor' is one of the most important points in helmet use; those which are poorly ventilated and heavy will not be worn. Even serious racers who agree helmets are needed do not always wear them, viz: on the mountain stages of the last Tour de France, where extremes of effort and heat are encountered. Yes, a helmet will help protect your head, but we should proceed by education rather than legislation.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"62"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19436784","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}

引用次数: 0

The cost of treatment of deliberate self-harm. 故意自残的治疗费用。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.8

H M Yeo

引用次数: 38

The introduction of automatic blood pressure monitoring to an accident & emergency resuscitation room. 在事故和紧急复苏室引入自动血压监测。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.39

S Cusack, C Moulton, I J Swann

引用次数: 1

Characteristics of emergency department utilization in the U.S.A. and the U.K.: a comparison of two teaching hospitals. 英美两国急诊科利用特点:两所教学医院比较。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.48

D A Rund, J A Nemer, M Moeschberger, C Robertson, M Garraway

{"title":"Characteristics of emergency department utilization in the U.S.A. and the U.K.: a comparison of two teaching hospitals.","authors":"D A Rund, J A Nemer, M Moeschberger, C Robertson, M Garraway","doi":"10.1136/emj.10.1.48","DOIUrl":"https://doi.org/10.1136/emj.10.1.48","url":null,"abstract":"Appropriate patient use of the accident and emergency (A&E) department has been a subject of concern in the medical literature of both the United Kingdom and the United States for years. Over a century ago the Lancet (1869) published a series of reports on outpatient visits in London hospitals. Citing the 'large numbers of apparently trivial cases' seen in out-patient departments, the authors urged curtailment of services. In more recent years, both Fry (1960) and Crombie (1959) concluded that a majority of patients attending their respective A&E departments in the U.K. had conditions that could have been managed by a general practitioner. In the U.K., both the Platt Report (1962) and the Expenditure Committee on Accident and Emergency Services (1974) recommended that non-urgent cases should first seek care from their general practitioner (G.P.), not the A&E department. In the U.S.A., the literature of the 70's estimated that between half and twothirds of patient visits were 'for routine primary health care'. (Gibson, 1978). In 1980 Gifford et al. reported the results of a survey of emergency department (ED) physicians in 24 hospitals. The assessment indicated that at least 33% of the patients could have safely waited over 12 h for care. A recent report indicated that 25% of patients in one E.D. used the department for routine care. Eighty-three per cent of such patients had public and/or self-pay insurance status (Pane et al., 1991). Despite some apparent similarities of non-urgent use patterns of emergency facilities in the U.K. and the U.S.A., we suspected that close inspection might reveal important differences in each patient population. The countries have quite different systems of medical care reimbursement for physicians and hospitals,","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.48","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19436781","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}

引用次数: 2

Transthecal digital block. 经鞘数字块。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.35

W G Morrison

引用次数: 28

Sternal fracture--a modern review. 胸骨骨折——现代回顾。

Archives of emergency medicine Pub Date : 1993-03-01 DOI: 10.1136/emj.10.1.24

I Johnson, T Branfoot

{"title":"Sternal fracture--a modern review.","authors":"I Johnson, T Branfoot","doi":"10.1136/emj.10.1.24","DOIUrl":"https://doi.org/10.1136/emj.10.1.24","url":null,"abstract":"Sternal fractures have long been regarded as a potentially serious injury or at least a marker thereof. A retrospective review presented here challenges this premise and questions the current management. Sternal injuries have been assessed since the 1860's when they were recorded to be both rare and associated with severe trauma (Guilt 1864). Over the next hundred years the incidence increased and a strong association with road traffic accidents (RTAs) became apparent (Helal, 1964). Indeed, by the early 1970's such was the preponderance of patients whose fracture was caused by a restraint that the injury was included in the 'Safety-belt syndrome' (Michelinakis, 1971). From the mid-point of the century evidence demonstrated that patients ought to be admitted and closely observed suggestions range from simple electrocardiogram to routine use of isotope scans and 2-D echocardiogram (Mayfield, 1984) in order that cardiac contusion and other complications should not be missed. This represents the core of the policy currently followed in the United Kingdom. The seat-belt law has recently been extended and hence a further increase in the frequency of this injury could reasonably be expected. A review of our cases was undertaken to see if these commonly held assumptions are true and whether a change in management is now required.","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"10 1","pages":"24-8"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.10.1.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19434847","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}

引用次数: 34

Causes of fatal childhood accidents in North Staffordshire, 1980-1989. 1980-1989年北斯塔福德郡儿童致命事故的原因。

Archives of emergency medicine Pub Date : 1992-12-01 DOI: 10.1136/emj.9.4.357

M J Bannon, Y H Carter, K T Mason

{"title":"Causes of fatal childhood accidents in North Staffordshire, 1980-1989.","authors":"M J Bannon, Y H Carter, K T Mason","doi":"10.1136/emj.9.4.357","DOIUrl":"https://doi.org/10.1136/emj.9.4.357","url":null,"abstract":"<p><p>Sixty-nine children aged under 15 years were identified from coroners' records as having died as a result of an accident between 1980 and 1989. Road traffic accidents (RTAs) accounted for the majority of cases (n = 38; 55% of total) and in almost all of these, the unsafe behaviour of the child was considered to be at fault. Most fatal accidents occurred between 15.00 and 21.00 hrs and within 2 km of the child's home; the majority of children killed were not supervised by an adult at the time of the accident. Considerable variation in mortality within the district was observed with several areas having a rate significantly higher than the district as a whole. Head injury was the most commonly recorded cause of death (n = 37, 53%) confirming the importance of head injury as a cause of childhood mortality. Road safety educational and engineering measures as well as adequate adult supervision and awareness could have prevented the vast majority of these accidental deaths. Coroners records are a vital and often poorly utilized source of locally relevant information regarding childhood accidents which should be of use to all interested agencies including child accident prevention groups.</p>","PeriodicalId":77009,"journal":{"name":"Archives of emergency medicine","volume":"9 4","pages":"357-66"},"PeriodicalIF":0.0,"publicationDate":"1992-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.9.4.357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12662277","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}

引用次数: 17