Journal of accident & emergency medicine
-
In this article we review the evidence supporting the clinical application of adrenaline in cardiopulmonary arrest, and summarize the receptor effects of catecholamines and the basic principles producing perfusion during CPR. Animal and human studies show that in cardiac arrest, adrenaline has positive haemodynamic effects, increasing systemic pressures, myocardial perfusion, and cerebrally directed flow. The problems extrapolating from animal to human data are highlighted. ⋯ There is no evidence that high doses of adrenaline improve survival to hospital discharge. Most studies comparing adrenaline with placebo have been non-randomised and uncontrolled, with major methodological problems. Conclusions are difficult, but if anything adrenaline is associated with poorer outcomes.
-
To investigate how often elderly patients are discharged from an accident and emergency (A&E) department with unrecognized but remediable problems. ⋯ Elderly patients attending A&E merit special consideration to detect underlying medical or social problems.
-
Splenic rupture in infectious mononucleosis is an extremely rare but often fatal complication. A case presented to the accident and emergency department in ventricular fibrillation seconds after losing signs of any cardiac output. The underlying cause of cardiorespiratory arrest always be sought irrespective of the presenting rhythm.
-
To estimate the proportion of prehospital deaths in a British population of trauma victims which may be preventable, and to investigate the effect of death at the scene and death in transit on potential survivorship. ⋯ There seems to be less scope for salvage of victims of trauma death in a British population than has been recorded in America, possibly due to a higher proportion of blunt trauma deaths here. Those who die in transit consist of a less severely injured group with a higher potential for survival.