Journal of accident & emergency medicine
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Traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more common, early diagnosis of tamponade is important so that life saving treatment can be started. The classical features of tamponade may be modified by hypovolaemia and the presence of associated injuries; acute tamponade may also be precipitated by rapid administration of large volumes of fluid. ⋯ Echocardiography is limited by availability and operator dependence. A high degree of clinical suspicion in patients with chest injuries, together with close monitoring and reevaluation, particularly during volume replacement, is essential. Four cases are described which presented to the accident and emergency department of Glasgow Royal Infirmary, in three of which there was a significant delay in the diagnosis.
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To present the legal and professional issues related to nurse administration of drugs according to protocols, and describe the implementation and initial audit findings of such a scheme. ⋯ There are no legal or professional obstacles to the development of protocols for the administration of drugs to patients by nurses without reference to a doctor, providing the protocols meet all the requirements of the UKCC and have the support of consultant medical staff. Such a system must be subject to regular audit to promote a dynamic approach to protocols and training. The system safely enhanced the quality of care of patients treated by ENPs in A&E.
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Comparative Study
Axillary brachial plexus block--an underused technique in the accident and emergency department.
To compare axillary brachial plexus block and Bier's block as methods of providing upper limb anaesthesia. ⋯ Brachial plexus blocks are an alternative form of providing upper limb anaesthesia in the accident and emergency department. They are relatively simple to perform, well tolerated by patients, and have the advantage of providing prolonged analgesia without the need for additional medication.
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Comparative Study
Medical involvement in prehospital care--a transatlantic comparison.
The role of doctors in prehospital care in the United Kingdom and the USA was compared using information obtained from a visit to the city of Houston emergency medical service (Houston, Texas) and from a review of published reports. The involvement of full time specialist emergency medical services physicians has been crucial to the development of improved standards of practice within American prehospital care. The specialty of accident and emergency medicine should support provision of medical advice to the ambulance services by closer liaison with ambulance service trusts and the formalisation of training in prehospital care to specialist registrars.
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To examine 105 successive negligence claims against NHS accident and emergency (A&E) departments in the United Kingdom and to highlight risk management points. ⋯ SHOs employed in A&E departments need careful training and supervision, with ready access to senior medical advice, both clinical and radiological. Most errors leading to claims appear in retrospect to have been simple failures of history taking, physical examination, interpretation of radiographs, and communication. Poor quality notes imply substandard care. About half the claims were found to be indefensible.