ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124620.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Valid epidemiological and clinical research methods should be used to assess management of poisoning

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124621.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Multidimensional care can improve outcomes for old people

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124622.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

The balancing act between safety, cost and pressure on scarce donor resources should not be left to individual clinicians or their patients

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124623.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Giving the right agent to the right patient at the right time may be the future of stroke management

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124624.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose.DesignProspective randomised controlled trial, with subjects presenting on odd‐numbered dates allocated to the emptied group (E), and those on even‐numbered dates to the not‐emptied group (NE).SettingPrincess Alexandra Hospital, Brisbane (a tertiary referral hospital), which serves an adult urban community, between 4 January 1988 and 11 June 1990.SubjectsConsecutive patients (13 years or older) who presented to the Emergency Department after ingesting an overdose of one or more compounds able to be adsorbed by activated charcoal.InterventionsAll patients received charcoal by the oral or nasogastric route. Those in the E group also had gastric emptying by ipecac‐induced emesis or gastric lavage.Outcome measuresClinical course during the first six hours after treatment began, length of hospital stay, complications.Results876 patients were eligible for the study. There were no significant differences between the E and NE groups in age and sex distribution, severity of the overdose or other characteristics, except the mean interval between presentation and administration of charcoal (91 min [SD, 52] for E group and 55 [SD, 41]for NE group;P= 0.0001). There were no significant differences between the E and NE groups in outcome, even when the groups were stratified for severity of the overdose or into subgroups that presented sooner or later than one hour after ingestion.ConclusionsGastric emptying can be omitted from the treatment protocol for adults after acute oral overdose.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124625.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo optimise collection of sufficient autologous blood for elective surgery.MethodsProspective study of 40 patients referred for donation of autologous blood, who were booked for elective orthopaedic surgery in the period August 1992 ‐ September 1994. Patients received recombinant erythropoietin (r‐EPO) to stimulate erythropoiesis, and sufficient iron by injection so that iron deficiency did not limit the bone marrow response to the r‐EPO.ResultsThirty‐eight of the 40 patients treated with this protocol stored an average of 3.7 units each on a twice‐weekly donation schedule. Only one patient required supplemental homologous blood (two units) in subsequent surgery. One patient developed persistent hypotension, and one a late reaction to parenteral iron (which was controlled with corticosteroids). There were no other adverse events.Conclusionsr‐EPO in combination with parenteral iron is a safe and effective method of ensuring the collection of optimal amounts of autologous blood before surgery.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124626.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124627.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine blood products used, clinical outcomes and frequency of haemostatic complications of massive blood transfusion.Design and settingRetrospective review of the medical records of patients receiving more than 10 units of blood in 24 hours at a tertiary referral hospital in 1993.PatientsForty‐three patients fulfilled this criterion. The major reasons for massive transfusion were trauma (46%; 20 patients), gastrointestinal bleeding (21%; nine patients) and leaking abdominal aortic aneurysm (14%; six patients).Main outcome measuresBlood products used, platelet count (<50 × 109/L in first 48h), prothrombin time (PT) and activated partial thromboplastin time (APTT) (twice normal in first 48 h), microvascular bleeding, and survival.ResultsThe 43 patients used 824 units of packed cells (15.2% of the total used in 1993), 457 units of fresh frozen plasma (FFP) (17.1% of the 1993 total) and 370 units of platelets (14.8% of the 1993 total). Overall, these patients consumed 16% of the total number of units of blood product used in 1993 for 1478 transfusion episodes. The overall survival rate was 60%. Severe coagulopathy occurred in 19 patients (44%) (mortality rate, 74%), and 13 (31%) had severe thrombocytopenia (<50 × 10'/L). There was no significant correlation between the severity of coagulopathy/thrombocytopenia and total units transfused, or between the age of the units of blood and development of coagulopathy or microvascular bleeding.ConclusionsSevere coagulopathy is common after massive transfusion In the absence of clear correlation with the number of units transfused, “formula” replacement with plasma and platelets is unlikely to avoid tht problem. Duration of tissue hypoperfusion and platelet consumption are likely to be more important than simple haemodilution of coagulation factors.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124628.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine the incidence of exaggerated hearing loss in people claiming workers compensation for noise induced hearing loss, as well as the ability of a range of testers to detect this exaggeration.Subjects333 people who claimed compensation for noise induced hearing loss between 13 September 1993 and 31 July 1994 in Victoria and who had undergone two independent subjective hearing tests.MethodThe hearing test results and referral decisions made by testers were examined in the light of the results of a single objective hearing test (cortical evoked response audiometry).ResultsThe incidence of exaggerated hearing loss was 17.7%. Testers performing the first subjective hearing test detected only 2.2% of claimants who exaggerated. The audiologist performing the second subjective test detected 94.2% of claimants who exaggerated.ConclusionsThe high incidence of exaggerated hearing loss and the large difference in ability to detect this exaggeration by the two groups of testers demonstrate the need for appropriate test procedures to be followed and a second hearing test to be reintroduced. Without accurate testing, there will be overpayment for noise induced hearing loss claims.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124629.x

出版商:Wiley    

年代:1995

数据来源: WILEY