Archives of emergency medicine
-
Comparative Study
Intracardiac therapy following emergency thoracotomy in the accident and emergency department: an experimental model.
For a select group of patients with penetrating chest trauma, immediate thoracotomy in the accident and emergency department offers the only chance of survival. Foley catheters have been used to achieve haemostasis in cardiac wounds but are not widely used for intracardiac fluid and drug administration during resuscitation. In an anatomical model designed to assess this procedure an average flow rate of 275 ml min-1 was achieved. The equipment required is readily available and easily assembled.
-
Definitive airway control which may require endotracheal intubation with or without an induction agent and muscle relaxant is an essential component of trauma resuscitation. We reviewed the delivery of advanced airway care in the resuscitation room of a regional trauma centre. This prospective survey suggests that in the absence of an experienced anaesthetist, A&E staff with a background of suitable training and experience may undertake the anaesthetic responsibility associated with securing a definitive airway when the situation demands.
-
to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly. ⋯ until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur.
-
An irregular discharge (ID) from the A&E department is an undesirable, but relatively common occurrence. A prospective study was undertaken to quantify the size of the problem and by arranging a subsequent review of the patient, to determine the clinical outcome. Over a 3-month period, 139 patients (0.73%) of attendances) took their own discharge against medical advice. ⋯ Patients with serious conditions appeared to return spontaneously for further care. Methods of minimizing the numbers of patients who take an ID or DNW are discussed. Taken together, the numbers of these attenders leaving prematurely, can be used as a valid performance indicator of the delivery of health care in the A/E department.