ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The objective of this study was to assess analgesic use and the use of a pain scoring system on those children presenting to a paediatric accident and emergency (A&E) department with a history of injury due to trauma. A random sample of patients who presented to a paediatric A&E department over a 6-week period with a history of limb trauma were prospectively studied. Pain severity scores were assessed on arrival and at 10, 30 and 60 minutes using the Douhit Faces Scale and any analgesia given or plaster application was noted. One hundred and seventy-two patients were studied. The median age was 10 years (range 3–13 years) and the majority, 56%, were male. The mean initial pain scores were 2.7 (range 1–4) for boys and 3.0 (range 1–4) for girls. The presenting injuries were 103 upper or lower limb fractures and 69 ‘soft tissue’ injuries. Only 84 (49%) patients received analgesic medication in the department (30% morphine; 70% paracetamol); analgesia was not given to the remaining 88 (51%). Of these, 7 declined analgesia, and 5 had already taken analgesia on arrival to A&E. Despite prompt triage (median time 2 minutes, range 0–10 minutes), the median time from arrival to paracetamol administration was 20 minutes (range 4–105 minutes) and for morphine was 14 minutes (range 2–57 minutes). Pain is a common symptom in patients presenting to A&E. Because children's pain can be particularly difficult to assess, a pain scoring system such as the Douhit Faces Scale can be a useful means of pain assessment in the A&E setting. Despite increased awareness, pain is still under treated in the A&E department.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Acute poisoning in children is still a major public health problem, and represents a frequent cause of admission in emergency departments. We carried out an epidemiological study of poisonings leading to admission to a paediatric emergency care unit (PECU). We analysed data from 2988 children who were admitted to the PECU of Bordeaux, France with acute poisoning from 1989 through 1995. During the 7-year period, the poison exposure numbers decreased slightly from 490 to 382 (6% vs. 3% of total medical emergencies). This represented a mean annual incidence of 1.4 poison exposures per 1000 children younger than 18 years of age and living in Bordeaux and its surroundings. Characteristics of the study population, circumstances of poisoning and substances involved were similar to those previously described. Eighty per cent of children were younger than 5 years of age, presented with a benign course. Forty per cent were not treated and 75% were discharged home either immediately or within 24 hours of admission. Only 1.5% of cases, mainly adolescent girls who attempted suicide, were admitted to a paediatric intensive care unit. Overall mortality rate was 0.33/1000. In children, most cases of acute poisoning are accidental, benign, and mainly attributed to the ingestion of a non-toxic substance. This points to the need for better information of the population on availability of poison control centre calling facilities, in order to decrease the number of admissions to the PECU. Patients suspected of having ingested a potentially dangerous substance can be managed in short-stay observation units, thus avoiding unnecessarily prolonged hospitalization. Acute poisoning in children remains a frequent problem, highlighting the need to develop an education programme on primary prevention in our region.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom free. The mean age was 6 years with equal right/left distribution. No child underwent hip aspiration and no cases of sepsis were missed. The median size of hip effusion detected on ultrasound at presentation was 9 mm. At 7 days 60% (15/25) of patients had a normal clinical examination with no detectable effusion on ultrasound. At 14 days 16% (4/25) had an effusion detectable on ultrasound but they were all pain and limp free and their effusions were reducing in size. These results support the known benign nature of TS and that it will settle with conservative treatment.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Core data according to the Utstein template was compiled from all out-of-hospital resuscitations in the city of Bodø, Northern Norway, over 7 years (1992–98). Out of a population of 34 500, 149 resuscitations were attempted. A cardiac aetiology was present in 123 patients and their median age was 72.1 years. Eighteen of the 96 patients having suffered a witnessed arrest of cardiac origin were alive after 1 year (18.8%). Fifteen had the best cerebral performance score (scale 1–5) and three had a score of 2. Survival among all resuscitated patients (149) was 18.8% also, giving a number of 62 attempted resuscitations and 11.2 survivors per 100 000 inhabitants per year, respectively. Thirty-three per cent of witnessed cardiac arrests with ventricular fibrillation or ventricular tachycardia survived to discharge, but only 7% with asystole. When the arrest was witnessed, median response time was 5 minutes, and was 3 minutes for the survivors. To our knowledge, this is the highest survival of out-of-hospital arrests in Scandinavia reported so far, and is chiefly explained by short turnout distances.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We performed a prospective study to describe the broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in referred patients, self-referred patients and patients rushed in by ambulance. The final diagnosis in a consecutive case series of 578 chest pain patients was established after discharge from the hospital. The underlying disorders were grouped into cardiac, respiratory, gastro-oesophageal disorders, musculoskeletal pathology, somatization disorders, other diseases and unknown. For comparison of the frequencies of the disease categories the Chi-squared test was used. Out of 578 patients, 161 (27.9%) were self-referred, 369 (63.8%) were referred by the general practitioner and 48 (8.3%) were rushed in by ambulance. Cardiac diseases represented 51.7% of the cases, myocardial infarction and unstable angina 19% and 12.8% respectively. Cardiac diseases were statistically significantly less common in self-referred patients (p<0.0005). Pulmonary diseases encompassed 14.2% of the population, followed by somatization disorders (9.2%), musculoskeletal pathology (7.1%) and other causes (4.3%). In 11.1% of the cases no definite final diagnosis could be established. Somatization disorders were significantly more frequent in self-referred and ambulance patients. Cardiac and pulmonary problems are the most frequent underlying disorders in acute chest pain patients in the emergency department. Somatization disorders and musculoskeletal pathology represented respectively 19.1% and 14.8% of the non-cardiac causes. The referral pattern influenced significantly the distribution of the disease categories with more cardiac and less psychiatric disorders in referred patients.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In this study, we screened a total of 6723 consecutive patients with chest pain and ECG non-diagnostic for acute myocardial infarction (AMI) on presentation to the emergency department (ED). The aim of the study was to avoid missed AMI, improve safe early discharge and reduce inappropriate coronary care unit (CCU) admission. Chest pain patients were triaged using a clinical chest pain score and managed in a chest pain unit (CPU). Patients with a low clinical chest pain score were considered at very ‘low-risk’ for cardiovascular events and discharged from the ED; patients with a high chest pain score were submitted to CPU management. Observation and titration of serum markers of myocardial injury were obtained up to 6 hours. Rest or stress myocardial scintigraphy (SPECT) was performed in patients >40 years or with ≥2 major coronary risk factors. Exercise Tolerance Test (ETT) or Stress-Echocardiogram (stress-Echo) were performed in younger patients or with <2 coronary risk factor, or unable to exercise, respectively. We discharged directly from the ED the majority of patients (4454; 66%): in this group there was only a 0.2% final diagnosis of coronary artery disease (CAD) at follow-up. The remaining 34% of patients, with non-diagnostic or normal ECG, were managed in the CPU. In this group, 1487 patients (representing 22% of the overall study group) were found positive for CAD, two-thirds because of delayed ECG or serum markers of myocardial injury, and one-third by Echo, SPECT or ETT. In conclusion, CPU based management allowed 22% early detection of myocardial ischaemia and 78% early discharge from the ED avoiding inappropriate CCU admission and optimizing the use of urgent angiography.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Noninvasive ventilation using noninvasive bilevel positive airway pressure (Bi-PAP) has been shown to be an effective means of improving oxygenation and respiratory status in patients with obstructive pulmonary disease (COPD) and acute congestive heart failure (CHF). However, it is uncertain what effects this positive airway pressure has on the haemodynamic condition of these patients. This study examines the acute changes in basic circulatory parameters with the initiation of Bi-PAP. Noninvasive measurements of the heart rate, systolic and diastolic arterial pressure, cardiac index, total peripheral resistance, ventricular ejection time, and total diastolic time were determined by impedance cardiography before and after the institution of Bi-PAP (pressures 15/5) in a group of healthy volunteers. In a collateral study, the same measurements were made in COPD patients in whom Bi-PAP was initiated for therapeutic reasons. Changes in the haemodynamic parameters were analysed using a pairedt-test (p<0.05). In the 12 healthy volunteers studied there were no significant differences in any of the haemodynamic parameters measured (average cardiac index: 2.75±0.78) over a period of 15 minutes after the placement of Bi-PAP. Similar results for most haemodynamic parameters were found in the 7 COPD patients with imminent respiratory failure (average respiratory rate 24.8±3.2) when Bi-PAP was utilized with the exception of significant but small increases in the cardiac index, stroke volume and oxygen saturation (p<0.05). While Bi-PAP is frequently used in the treatment of patients with acute respiratory failure, little is known about its effect on haemodynamics. This study suggests that the effects of the initiation of Bi-PAP on the general circulation and cardiac output may be of minor relevance.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

P-R segment depression is an early ECG change in the evolution of acute pericarditis. This is widely recognized in the USA and appears in several major emergency medicine texts. A telephone survey was conducted to gain an overview of the knowledge of accident and emergency career doctors in the UK. We hope to use the results to highlight this potentially useful sign. One hundred accident and emergency departments, listed in the 1999 British Association for Accident and Emergency Medicine as seeing more than 40 000 new patients per year, were contacted in a telephone survey. The registrar, staff grade or consultant on call was asked to respond to a brief questionnaire. One hundred accident and emergency (A&E) specialist doctors were contacted—60 specialist registrars, 23 consultants and 17 staff grades. Of those questioned, 24% had a background in general medicine. The remainder had trained in surgery, A&E medicine or anaesthetics. None of the doctors questioned volunteered knowledge of P-R depression when asked an open question. Six doctors (6%) admitted, when prompted, to having previously heard of this sign. Knowledge of P-R segment depression is not widespread amongst UK A&E specialists. It is a potentially useful early electrocardiogram change in the evolution of acute pericarditis. Its recognition may aid diagnosis and prevent the inappropriate administration of thrombolytic therapy.

ISSN:0969-9546    

出版商:OVID    

年代:2002

数据来源: OVID