Journal of accident & emergency medicine
-
Case Reports
Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency.
Severe accidental hypothermia in an urban environment is usually associated with drug or alcohol abuse or serious illness in elderly or debilitated patients. In the presence of cardiovascular instability, extracorporeal rewarming by cardiopulmonary bypass is the gold standard of treatment of such patients. Three cases of profound hypothermia with circulatory collapse are presented. ⋯ All three cases had a serum potassium in the normal range at the start of treatment. Where facilities exist, extracorporeal rewarming can be performed in A&E for patients with profound hypothermia and circulatory collapse. Cardiopulmonary resuscitation must be continued throughout the rewarming process.
-
To examine 105 successive negligence claims against NHS accident and emergency (A&E) departments in the United Kingdom and to highlight risk management points. ⋯ SHOs employed in A&E departments need careful training and supervision, with ready access to senior medical advice, both clinical and radiological. Most errors leading to claims appear in retrospect to have been simple failures of history taking, physical examination, interpretation of radiographs, and communication. Poor quality notes imply substandard care. About half the claims were found to be indefensible.
-
To investigate the use of a simple intrasound device in the detection of malleolar fractures in the accident and emergency (A&E) department. ⋯ The use of intrasound in the detection of malleolar fractures cannot be relied upon alone, but it may help to limit the number of x rays taken unnecessarily. A further study is proposed to confirm these findings.
-
Traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more common, early diagnosis of tamponade is important so that life saving treatment can be started. The classical features of tamponade may be modified by hypovolaemia and the presence of associated injuries; acute tamponade may also be precipitated by rapid administration of large volumes of fluid. ⋯ Echocardiography is limited by availability and operator dependence. A high degree of clinical suspicion in patients with chest injuries, together with close monitoring and reevaluation, particularly during volume replacement, is essential. Four cases are described which presented to the accident and emergency department of Glasgow Royal Infirmary, in three of which there was a significant delay in the diagnosis.
-
To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients. ⋯ Capnography may be used as a means of continuous respiratory monitoring in non-intubated acutely ill patients. Capnogram analysis may be used to indicate airway obstruction in these patients. Further work is required to correlate curve indices to degree of airway obstruction.