Journal of accident & emergency medicine最新文献

Objectives: The aim of this study was to compare morphine and pethidine in patients with clinically suspected renal colic with regard to analgesic efficacy, patient satisfaction and side effects.

Methods: double blinded, randomised controlled trial.

Results: There was no significant difference between morphine and pethidine with respect to any of the parameters measured.

Conclusion: Because of the well known adverse effects that may be associated with pethidine use, the authors recommend that morphine should be the preferred agent in suspected renal colic, when an opioid analgesic is to be used.

Objective: To determine factors associated with vomiting after minor head injury in a paediatric population with the intention of defining the role of vomiting in management decisions.

Methods: A prospective study of all patients presenting with minor head injury to the Royal Hospital for Sick Children, Edinburgh, between 1 May and 30 June 1997. Information regarding basic demographics, features of the head injury and past and family history was noted on a proforma. This included mechanism of injury, site of impact, presence or absence of scalp haematoma, skull fracture or brain injury and intrinsic factors such as age, family history of migraine and a personal history of migraine, its childhood variants and associated conditions. The relation between vomiting and these features was analysed using chi2 and Fisher's exact tests.

Results: 563 children aged from birth to 13 years presented with minor head injury. Complete data were obtained on 463 patients. Some 15.8% vomited after minor head injury. Comparing vomiters with non-vomiters the only associated factors that could be identified were a past history of recurrent vomiting or motion sickness (p= 0.0035, p=0.036 respectively).

Conclusions: Vomiting after minor head injury seems to be related to individual intrinsic factors rather than specific features of the head injury and its role in management decisions needs to be explored further.

Migraine can be a disabling condition for the sufferer. For the small number of patients who fail home therapy and seek treatment in an emergency department, there are a number of therapeutic options. This paper reviews the evidence regarding the effectiveness and safety of the following therapies: the phenothiazines, lignocaine (lidocaine), ketorolac, the ergot alkaloids, metoclopramide, the "triptans", haloperidol, pethidine and magnesium. Based on available evidence, the most effective agents seem to be prochlorperazine, chlorpromazine and sumatriptan, each of which have achieved greater then 70% efficacy in a number of studies.

Objectives: To investigate the pattern and frequency of use of computerised clinical guidelines (CCG) in an accident and emergency department.

Methods: A software program was written to record information on a central database each time the CCG were used. Data were collected prospectively for a six month period. Users were blind to the study. The date, time of use and guidelines consulted were recorded.

Results: 1974 individual sessions were logged comprising of 10204 "hits". The CCG were used for a median of 10 sessions per day (range 1-38, SD 5.49). A median of three subjects were accessed during each session (range 1-39, SD 5). The CCG were used most often during peak daily activity; 11 am (609 hits), 5 pm (678 hits) and 12 pm (604 hits) and on Sundays (1875 hits), Thursdays (1770 hits) and Saturdays (1608 hits). The most frequently used guidelines concerned orthopaedics and fracture management (1590 hits), wound care (546 hits), poisoning (473 hits), medical emergencies (267 hits) and radiological policy (148 hits).

Conclusions: In this department CCG have become easily integrated as part of normal day to day working practice. The CCG are accessible 24 hours a day. They can also be easily updated according to best evidence, local policy or national guidelines. The results of this study have helped the authors to focus education to areas of clinical need.

Objectives: (1) To evaluate the use of a standardised neurosurgical referral letter in terms of compliance, completeness and clinical relevance. (2) To compare the clinical information provided on the standardised neurosurgical letter with that provided by referring hospitals that used alternative documentation.

Design: A six month prospective audit was conducted in south west Scotland. Consultant neurosurgeons were asked to weight key clinical variables on the neurosurgical referral letter (NRL). Postal surveys of 114 referring accident and emergency (A&E) staff and 18 neurosurgical receiving staff were undertaken to determine the clinical relevance of the NRL. Case notes were examined for the presence and level of completeness of the NRL. In the absence of the NRL, a form was completed retrospectively using data from the referring hospital's letter. This enabled comparison of the NRL with routine hospital letters in terms of the availability of key clinical information.

Results: 139 adult patients were identified as suitable for inclusion: 99 patients were transferred from 11 hospitals with access to the NRL. The compliance rate for use of the NRLwas 82%. Forty patients were transferred from nine hospitals that did not have access to the NRL. The completion rate of key variables on the NRL was higher than when an ordinary letter was sent: 87% compared with 38%. The NRL was considered useful by 67 of 71 (94%) A&E questionnaire respondents and by 14 of 15 neurosurgeons who responded.

Conclusions: The widespread acceptance of the NRL and its ability to provide essential clinical information in a concise format not available in routine hospital letters indicates that national, standardised documentation can be implemented if users are involved in both its design and implementation.