Journal of accident & emergency medicine
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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.
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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.
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To present the legal and professional issues related to nurse administration of drugs according to protocols, and describe the implementation and initial audit findings of such a scheme. ⋯ There are no legal or professional obstacles to the development of protocols for the administration of drugs to patients by nurses without reference to a doctor, providing the protocols meet all the requirements of the UKCC and have the support of consultant medical staff. Such a system must be subject to regular audit to promote a dynamic approach to protocols and training. The system safely enhanced the quality of care of patients treated by ENPs in A&E.