Archives of emergency medicine
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Mechanical ventilation in critically ill patients is usually performed with the conventional endotracheal airway. The esophageal tracheal combitube (ETC) is a new device for cardiopulmonary resuscitation, conceived to bridge the gap between hospital and prehospital phases. The ETC may be used in esophageal and endotracheal positions. ⋯ Blood gas data showed adequate ventilation with the ETC during the observation period. Data suggest that mechanical ventilation with the ETC is possible for several hours after cardiopulmonary resuscitation. This might be helpful during the initial post-arrest period, when replacement of the ETC by a conventional endotracheal airway might destabilize a vulnerable patient.
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The aim of this study was to demonstrate that the under-used technique of femoral nerve block (F. N. B.) (Berry, 1977) has excellent analgesic action for femoral shaft fractures when performed by junior staff. ⋯ N. B. using a different agent (10 ml 0.5% bupivacaine) was performed and the same parameters were assessed. Both agents gave effective analgesia of varying duration at all levels of fracture site.
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Midazolam meleate, a water soluble 1,4 benzodiazepine, was used intravenously in 20 patients suffering seizures, of whom 12 were in status epilepticus. In all cases, midazolam in a dose of 2.5-15 mg rapidly terminated the seizure. ⋯ Thirteen patients were taking some form of anticonvulsant medication but only three were in the therapeutic range. Midazolam is seen to be an effective agent in the emergency treatment of seizures.
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The perceived urgency of 2000 consecutive patients attending the Accident and Emergency Department of the Royal Infirmary, Edinburgh, was assessed using a Linear Analogue Scale. Each patient was assessed by the receptionist, the receiving nurse and the treating doctor. The distribution of urgency rating produced for this patient group was shown to be comparable for each status of assessor, and to correlate with other outcome criteria such as admission and referral rates. ⋯ However, the complexity of many of these scales, together with the difficulty in usage of so many different scales, begs a reappraisal of the overall triage of patients attending the emergency department. The aim of this study was to look at the perceived urgency distribution of patients presenting to the emergency department. We wished to compare the relative assessment of urgency by various levels of treating staff and to compare those assessments with the referral and outcome of these patients to provide the basis for the development of a comparative Triage Scale.
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A prospective survey of cardiopulmonary resuscitation is in progress in the Accident and Emergency Department of the Royal Hallamshire Hospital. During the 12 months from January 1985 to January 1986, 123 cardiac arrests were treated in the accident department. ⋯ Of the 33 people arresting in the department, 10 survived to leave hospital. The causes of death are presented.