ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. The patients hospitalized due to firearm injuries were compared with a control group composed of 141 individuals matched pair-wise for sex and age. The total morbidity during the follow-up period of on average 10 years was higher among patients compared with controls concerning both somatic diseases and injuries. All cases of severe psychopathology were found in the patient group. Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Patients with methamphetamine toxicity often present to the emergency department (ED) agitated, violent and psychotic. To determine the efficacy of a benzodiazepine versus a butyrophenone for chemical restraint we conducted a prospective, randomized study at a large urban university ED between January 1995 and January 1997. Patients were randomized to receive either lorazepam or droperidol intravenously. A 6-point sedation scale was devised, with 6 representing extreme agitation and 1 deep sleep. Sedation scores were recorded at time 0, 5,10, 15, 30 and 60 min. Vital signs were recorded at time 0 and at 60 min. If sedation was inadequate, repeat dosages of each drug could be repeated at 30 min. Toxicology screen, ethanol and creatinine phosphokinase levels were obtained. A total of 146 patients were evaluated. Seventyfour patients received lorazepam and 72 received droperidol. Both drugs had similar sedation profiles at 5 min. Patients receiving droperidol had significantly improved sedation scores at times 10, 15, 30 and 60 min than lorazepam (p<0.001). More repeat doses of lorazepam were given (26) than droperidol (6) at 30 min. Both drugs produced significant reductions in pulse, systolic blood pressure, respiratory rate, and temperature over 60 min. We conclude droperidol produces a more rapid and profound sedation than lorazepam for methamphetamine toxicity. Lorazepam is more likely to require repeat dosing than droperidol.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Paramedic training and skills have been introduced in the United Kingdom in an attempt to improve prehospital patient care. There is presently little control and quality assurance in this potentially difficult environment and paramedic protocols have not been validated. We studied the use of nalbuphine by paramedics for patients with major injury in West Yorkshire. A case-control study was carried out using two cohorts of patients from the regional Major Trauma Outcome Study (MTOS) database; one group had received prehospital nalbuphine by paramedics (the intervention) and a matched group who had not (the control). Both groups of patients were reviewed by a panel of three consultants and a paramedic to assess which patients received or could have received nalbuphine appropriately. Only 85 patients from a database of 4170 patients received nalbuphine. Fifty-two (61%) patients were thought by the panel to have been given nalbuphine appropriately. The panel also concluded that 21 (18%) of the 115 patient control group could have been administered nalbuphine but did not receive the drug. This study demonstrates inadequate and sometimes inappropriate use of nalbuphine in prehospital trauma care. Quality assurance and audit systems should be implemented to identify and correct these deficiencies.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of the study was to evaluate the referral of outpatients with non-traumatic conditions for radiographic examinations and to assess the impact of the radiological report on the patient's management in an emergency department. In a prospectively designed study 1223 X-ray examinations of 1116 non-trauma outpatients (640 males, 476 females; mean age: 44 ± 18 years) requested over a 10-month period were evaluated. Patients were classified into four groups according to the presenting complaints (respiratory, abdominal, neurological or non-specific symptoms). Analysis of data included the influence of age and presenting symptoms on the likelihood of abnormal radiological findings and the impact of the radiological result on the further management of the patient. In 455 (40.8%) patients an abnormal radiological result was observed. The likelihood of an abnormal radiological finding increased with age (age <40 years: 33%; age >40 years: 47%;p<0.05). Whereas the rate of abnormal radiological findings was high in patients with specific symptoms (respiratory: 69%; abdominal: 37%; neurological: 38%), in patients with non-specific symptoms only 25% of all radiological examinations revealed an abnormality. The radiological result had an impact on the further management in 948 (85%) patients. As 45% of all radiographic examinations revealing a normal radiological result had a clinical impact, normal radiological reports are just as helpful as abnormal radiological findings in the management of non-trauma outpatients in an emergency department. Thus, we assume that the radiological result has a major impact on the management of non-trauma outpatients in the emergency department.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

To explore the efficacy of single dose ciprofloxacin therapy in cholera, a randomized, open, controlled clinical trial was carried out. Seventy-four adult patients with positiveVibrio cholerae01 isolates were assigned to receive either ciprofloxacin in a single dose of 1 g (CIP1), or ciprofloxacin 500 mg b.i.d., for 1 day (CIP2), or doxycycline 100 mg b.i.d., for 3 days (D), or, for control, no antibiotics. Mean liquid stool output volume did not show any statistically significant difference among CIP1, CIP2 and doxycycline groups. The mean duration of diarrhoea in CIP1 group, on the other hand, was significantly lower than that from the D group (p=0.004), and the control group (p<0.001). Bacteriologic clearance at the fourth day of treatment were 95.2% for CIP1, 89.5% for CIP2, 90.5% for D group and 15.4% for the control group. We conclude that a single 1 g ciprofloxacin dose is equivalent to doxycycline in its bacteriologic success but has advantages in shortening the duration of diarrhoea and simplicity of use as a single dose.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Diagnostic peritoneal lavage (DPL) remains an accurate diagnostic test for intra-abdominal injury. This study examined the safety and efficacy of DPL performed by supervised residents in an urban trauma centre. A retrospective chart review was carried out of a one year experience (July 1994-June 1995). Junior surgical and senior emergency medicine residents rotating on the Trauma Service performed an open DPL by protocol under the direct supervision of senior surgical residents. Standard criteria were used for diagnosis. During this study, 1349 injured patients were admitted to the Trauma Service. Of these 525 patients underwent DPL. Complete records were available on 516 patients. The average age of the patients was 33 years and injury was primarily blunt (95%). There were 72 true positives, 428 true negatives, two false positive and seven false negative DPLs; for a sensitivity of 91.1%, specificity of 99.5% and accuracy of 96.9%. Complications occurred in 12 patients (2.3%): non-diagnostic DPL—7 (1.3%); intra-abdominal injury—4 (0.8%); wound complication—1 (0.2%). Seven patients underwent nontherapeutic laparotomy for a positive DPL. Thirty-four patients (6.6%) died, none from the DPL. DPL obviated the need for computed tomography scan of the abdomen and /or pelvis in 464 patients resulting in a cost saving of approximately $250 000. DPL performed by supervised junior surgical and senior emergency medicine residents is a safe and cost-effective method of evaluating patients with potential intra-abdominal injury.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Evidence-based medicine (EBM) is advocated by its protagonists as prototypical of, and therefore normative for, 'best professional practice', a position which has precipitated visceral anti-EBM sentiments within the international medical press. This article examines the nomenclature, claims, principles and practice of EBM, the matters of authority and competence in defining evidence for practice and how selective utilization of EBM findings will be employed by health service managers in an attempt to manage clinical decision making and ration the medical care of patients and populations.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Escherichia coli0157 infection disaster occurred in Sakai in the summer of 1996, in which over 6000 infections and three deaths occurred. Seventeen patients, including four girls with haemolytic uraemic syndrome, were treated successfully in our hospital and information was published, as quickly as possible, on our internet home page.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Mechanical airway obstruction secondary to retropharyngeal haematoma is a life-threatening emergency and should be anticipated in all cervical spine injured patients regardless of the severity of trauma. Most retropharyngeal haematomas described in the literature have involved complicating factors such as anticoagulant therapy tumour, aneurysm, infection or major cervical spine injury. Several authors have however described haematomas causing airway compromise with minor hyperextension injuries. We describe the case of a 19-year-old male who was involved in a motorcycle accident. He sustained an atlanto-occipital fracture-dislocation and a very large retropharyngeal haematoma which resulted in airway obstruction and a subsequent difficult intubation. We outline the normal anatomy of the retropharyngeal space, the pathogenesis of retropharyngeal haematomas, and outline techniques of intubation available.

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID