European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Safety and efficacy of diagnostic peritoneal lavage performed by supervised surgical and emergency medicine residents.
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). ⋯ 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.
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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. ⋯ 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.
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Escherichia coli O157 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.
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Poisoning is one of the most common reasons for acute medical admission to hospital in the UK. However, certain poisons are rarely implicated. Two unusual cases involving poisoning with atropine are presented. The clinical features were classical, but the way in which the patients became poisoned by drinking contaminated Indian tonic water was most unusual.
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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). ⋯ 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.