Journal of accident & emergency medicine
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Comparative Study
Contaminated casualties: are we prepared to receive them?
The NHS's reception of casualties contaminated by radiation is reviewed. The findings suggest that training, facilities and personal protection for hospital staff are inadequate.
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Multicenter Study Comparative Study
Review of the composition and use of trauma teams within the Trent Region.
The aim of the study was to find the existence, composition and working policies of trauma teams within the Trent Region. Data were obtained by postal survey. Despite many reports indicating a need for a unified multidisciplinary approach to trauma management, this study found that this approach was absent in many hospitals.
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Comparative Study
Management of minor head injuries in the accident and emergency department: the effect of an observation ward.
The management of 483 patients presenting with minor head injury to the accident and emergency (A&E) departments of two Scottish hospitals was studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currently accepted criteria for recommending admission to hospital and 49 (17.7%) patients were actually admitted. ⋯ However, significantly fewer, 10 (4.9%) patients, were actually admitted. The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds is a major determinant of management in patients presenting with minor head injury to the A&E department and may be more influential than clinical findings.
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Comparative Study
Analysis of emergency department interpretation of electrocardiograms.
The objective of the study was to determine the concordance of emergency physicians' and cardiologists' interpretations of emergency department (ED) electrocardiograms (ECG), to evaluate the impact of ECG misinterpretation on patient management, and to determine error rates as a function of the level of physician training and the specific ECG diagnoses. ECG interpretations were registered prospectively using a programmed-response data sheet. A second blinded interpretation by a staff cardiologist was assumed to be correct. ⋯ While discordance was significant, errors in ECG interpretation rarely impacted patient management. Prospective evaluation of ECG interpretation may be a useful means of gauging physician skills. It can also serve to focus educational activities on problem areas in electrocardiography.
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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.