Journal of accident & emergency medicine
-
Case Reports
Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency.
Severe accidental hypothermia in an urban environment is usually associated with drug or alcohol abuse or serious illness in elderly or debilitated patients. In the presence of cardiovascular instability, extracorporeal rewarming by cardiopulmonary bypass is the gold standard of treatment of such patients. Three cases of profound hypothermia with circulatory collapse are presented. ⋯ All three cases had a serum potassium in the normal range at the start of treatment. Where facilities exist, extracorporeal rewarming can be performed in A&E for patients with profound hypothermia and circulatory collapse. Cardiopulmonary resuscitation must be continued throughout the rewarming process.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine.
To establish whether there is any difference in the efficacy of a chlorpromazine regimen and a sumatriptan regimen for the management of the pain of acute severe migraine. ⋯ The chlorpromazine and sumatriptan regimens studied are both very effective for the relief of the headache of severe migraine.
-
To determine the number of and reasons for rapid sequence inductions done by accident and emergency (A&E) doctors out of hospital as part of the activities of the MEDIC 1 Flying Squad. "Rapid sequence induction" was defined as any attempted endotracheal intubation accompanied by use of drugs to assist intubation and ventilation, including opiates, benzodiazepines, intravenous and topical anaesthetics, and neuromuscular blocking drugs. ⋯ The lack of complications related to rapid sequence induction in prehospital care suggests that this technique is safe when done by A&E doctors on appropriate patients.
-
The case is reported of a man shot with a distress flare from a range of about 3 m. The flare caused a large cavity deep in the pectoral muscles. There should be a high index of suspicion about the extent of the injury in all types of penetrating trauma.
-
To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients. ⋯ Capnography may be used as a means of continuous respiratory monitoring in non-intubated acutely ill patients. Capnogram analysis may be used to indicate airway obstruction in these patients. Further work is required to correlate curve indices to degree of airway obstruction.