Journal of accident & emergency medicine
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Comparative Study
AB or ABC: pre-hospital fluid management in major trauma.
Pre-hospital trauma care in the United Kingdom is a neglected field with little consideration being given to this phase. Of the 14,500 annual fatalities from road traffic accidents in this country, 60% die before reaching hospital and it has been estimated that one-third of these fatalities are due to hypovolaemia. ⋯ By delaying departure to hospital, initiation of i.v. fluid replacement may actually worsen outcome. This paper reviews recent studies and discusses current thought on pre-hospital fluid replacement in major trauma.
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Case Reports Comparative Study
Aluminium ring pulls: an invisible foreign body.
The aluminium ring pulls associated with the latest designs of drinks cans can be relatively easily detached from their mounting on the top of the can and subsequently aspirated. Their small size predisposes them to lodge as foreign bodies (FBs) in the throat. The similarity of atomic number between soft tissue (7.5) and aluminium (13) makes detection of these FBs difficult on soft tissue radiography. If aspiration is suspected direct visualization and removal may be indicated even if radiography is negative.
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Transoesophageal echocardiography (TOE) was performed during closed chest cardiopulmonary resuscitation (CPR) in 18 subjects in cardiac arrest. Compression of all four cardiac chambers resulted in forward flow in the pulmonary and systemic circulations, retrograde pulmonary vein flow and incomplete mitral valve closure. ⋯ These findings support the cardiac pump theory of CPR and are incompatible with the thoracic pump mechanism. TOE merits further investigation as a device to monitor and guide resuscitation efforts during CPR.
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Comparative Study
Cardiopulmonary resuscitation. Paper 2: A survey of basic life support training for medical students.
This paper presents the results of a survey of Basic Life Support (BLS) training, based on experience gained by undergraduate medical students who had just completed their first clinical year (third year) at the University of Glasgow. Data were collected on the amount and quality of BLS training received, along with students' own perceptions of their confidence in providing BLS in a cardiac arrest resuscitation attempt. ⋯ Self-perceived confidence in performing BLS in an acute resuscitation situation is low. With no evidence to suggest that the situation is any different elsewhere in the UK, it is recommended that undergraduate resuscitation training is improved to reflect the importance that medical students attach to it.
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Comparative Study
Manipulation under sedation in the accident and emergency department.
The Royal College of Surgeons of England recently published guidelines for sedation by non-anaesthetists. The report emphasizes sedation for endoscopy and dental surgery, but the recommendations are equally relevant to accident and emergency (A&E) medicine. Current sedation practice for orthopaedic manipulations was determined by questionnaire in 58 A&E and orthopaedic junior staff in one teaching and one district general hospital. ⋯ None of the junior staff had received any formal training in sedation techniques. Thirty-one (62%) had attended a resuscitation refresher course within the last year. These results emphasize the need for training in sedation techniques for A&E and orthopaedic juniors and the importance of appropriate supervision.