Archives of emergency medicine
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We report on the outcome of major trauma patients brought to the Kent and Canterbury Hospital in 1989 and compare it with 1987. There is an improvement which followed changes in the management of serious injuries.
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Thirty-eight teaching hospital affiliated accident and emergency departments were surveyed by post to try to find if there had been any change in undergraduate medical student teaching over the past 10 years. Twenty-six departments replied. The results showed that although there has been an improvement in the teaching of A&E medicine to undergraduates in the past few years there are still some medical schools where an A&E attachment is not mandatory. In those departments providing teaching, there is wide variation in course duration and content.
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End-tidal carbon dioxide concentrations were measured prospectively in 12 cardiac arrest patients undergoing cardiopulmonary resuscitation (CPR) in an accident and emergency department. The end-tidal carbon dioxide (CO2) concentration decreased from a mean (+/- SD) of 4.55 +/- 0.88% 1 min after chest compression and ventilation was established, to values ranging from 2.29 +/- 0.84% at 2 min to 1.56 +/- 0.66% following 8 min of CPR. Spontaneous circulation was restored in five patients. ⋯ Changes in end-tidal CO2 values were often the first indication of return of spontaneous cardiac output. There was a significant difference in the end-tidal CO2 in patients undergoing CPR before return of spontaneous circulation (2.63 +/- 0.32%) and patients who failed to develop spontaneous output (1.64 +/- 0.89%) (p < 0.001). We conclude that measurement of end-tidal CO2 concentration provides a simple and non-invasive method of measuring blood flow during CPR and can indicate return of spontaneous circulation.
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Thirty-six patients were studied prospectively to assess the benefit of 'springing' the pelvis in traumatized patients, to confirm or refute a fracture of the pelvis. None of the patients was multiply injured and half of those with fractures were elderly, sustaining their injuries in simple falls. Springing the pelvis was a poor predictor of the presence or absence of a pelvic fracture, at best it yielded a specificity of 71% and sensitivity of 59%. Its routine use in clinical examination should be abandoned.