Journal of accident & emergency medicine最新文献

Purpose/background: Central retinal artery occlusion (CRAO) is usually a blinding event, and is not an infrequent presentation to the accident and emergency (A&E) department. The evidence-base in support of current treatment options is weak.

Methods: This paper reviewed the literature germane to the diagnostic, therapeutic and prognostic aspects of retinal arterial occlusive disease.

Results: The visual prognosis associated with CRAO remains poor, and current therapeutic practices are of unproven benefit. The non-ophthalmologist in the A&E department should lie the patient flat and give a stat dose of intravenous acetazolamide in an attempt to improve the retinal perfusion pressure.

Conclusion: The management of acute occlusion of the central retinal artery has not changed over the past 30 years, although the potential benefits of superselective intra-arterial fibrinolytic therapy warrant evaluation in a randomised controlled trial. The identification of underlying pathology is an essential component of medical care, and all cases should be followed up by an ophthalmologist because of the possibility of ocular rubeosis.

Objectives: To assess the degree of appropriate referral to the accident and emergency (A&E) department following the use of a community alarm where a mobile warden works in conjunction with the community alarm control centre.

Methods: 611 consecutive calls using community alarms underwent assessment and the appropriateness of referral to the A&E department was considered.

Results: Of 542 requests for help 44 patients were transported to the A&E department (8.1%). Twenty nine patients were admitted (5.3%) and 15 patients (2.8%) discharged home from the A&E department after assessment or treatment, or both. Only three patients (0.55%) had been referred to the A&E department inappropriately.

Conclusions: This study shows that where a mobile warden works in conjunction with the community alarm control centre the number of inappropriate referrals to the A&E department should be minimal.

Emergency medicine is a relatively new specialty area within medicine, however medical schools, students and standard setting bodies have recognised that learning emergency medicine is integral to the training of medical students. There are, however, significant problems with the delivery of emergency medicine teaching including low teacher numbers, severely limited teaching time and lack of suitable learning resources. This paper describes the process of development of a learning resource, its format and content and summarises student feedback.

This paper describes some of the injuries sustained by the aircrew who ejected from their aircraft after a mid-air collision, and discusses the types of injury that such patients may suffer.

Spinal cord injury without radiological abnormality is rare in adults. A case is described of a 61 year old man who fell 15 feet from a ladder striking his head on a wall who presented with neck pain and with motor and sensory neurological abnormalities in his limbs. Plain radiographs of the neck revealed no fractures or dislocations. Further imaging with computed tomography and magnetic resonance imaging revealed an osteophyte fracture with associated cord contusion at the C5 level. Careful neurological examination is essential in all cases of potential spinal injury.

Acute cerebrovascular accident in an otherwise well child is a rare presentation. A case is described where the diagnosis was delayed because of association with minor trauma and a misleading diagnosis of soft tissue injury.

Reducing drug related deaths has been identified as a priority by the British government. This study examined the link between drug related deaths in the community and prior contact with local accident and emergency (A&E) services. Most drug related deaths were found among male opioid users in their early 30s who had previously attended the local A&E department. It is suggested that A&E departments have a vital part to play, not only in the acute management but also in the prevention of drug related deaths in the community. Models for primary prevention, liaison and ongoing referral are discussed.