Archives of emergency medicine
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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.
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The object of this study was to assess the ability of junior doctors in the accident and emergency department to detect electrocardiographic (ECG) abnormalities. The ECG's performed in this department were monitored over a 4 week period. ⋯ Of those abnormalities which were graded as clinically significant only 2 (4.4%) were missed. The danger of missing acute changes is emphasized and proposals discussed which may reduce their frequency.
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Randomized Controlled Trial Clinical Trial
Reducing the pain of intradermal lignocaine injection by pH buffering.
The effect of pH on the pain of administration and efficacy of 1% lignocaine was investigated in a prospective, double-blind, randomized study of 20 adult volunteers. Onset and spread of anaesthesia by intra-dermal injection were not altered, but there was a significant reduction in pain scores with a higher pH. Overall, pain scores appear to be more dependent on the speed of injection rather than alteration of pH.
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Over a 1-month period all patients arriving in the accident and emergency department by ambulance following a '999' call were questioned using a standard proforma. They were assessed as to whether their medical condition warranted ambulance transfer. A number of social and practical points were analyzed to see whether they would identify any group of patients who used the emergency service without medical need. ⋯ Of these 178 (62%) were considered to have medically warranted an ambulance call whereas 111 (38%) did not. A number of features which were more likely to result in an unjustified call were identified. These would suggest that basic knowledge of first aid by the public is poor and should be improved.