ABSTRACT
BACKGROUND AND AIMS: Trauma is still the leading cause of mortality in the first four decades of life. Despite numerous reports on how trauma care could be improved in the UK, treatment has been shown to be inconsistent and of poor quality. Trauma teams have been shown to have a positive effect on outcome. A study was undertaken to determine the prevalence of trauma teams in Scotland. METHODS: A telephone survey was performed of 24 hospitals with emergency departments in which the senior clinician was interviewed regarding the provision of trauma teams. RESULTS: Five (21%) of the hospitals questioned had trauma teams. The most common reasons for not having one were no problem with the current system in eight cases (44%) and an inability to include sufficiently senior staff on the team in six cases (24%). CONCLUSIONS: There are few trauma teams in Scottish acute hospitals. There was little enthusiasm for introducing them for a variety of reasons. Local evidence of benefit is probably needed before their adoption becomes widespread.
Subject(s)
Emergency Service, Hospital/organization & administration , Patient Care Team , Wounds and Injuries/therapy , Health Care Surveys , Humans , Scotland , Specialization , TelephoneABSTRACT
AIM: To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation METHODS: A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation. RESULTS: 210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the re-emergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine. CONCLUSIONS: Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam.
Subject(s)
Anesthetics, Dissociative/adverse effects , Conscious Sedation/adverse effects , Ketamine/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia Recovery Period , Child , Decision Making , Emergency Service, Hospital , Female , Humans , Male , Medical Audit , Mental Recall , Middle Aged , Orientation , Professional Practice , Prospective StudiesABSTRACT
H5N1 has emerged as a highly pathogenic strain of avian flu. Cases of bird-to-human transmission have occurred and raised concerns that human-to-human transmission may be possible. Therefore, it is vitally important to isolate any index case arising from bird-to-human transmission. Questionnaires were sent out to emergency departments throughout Scotland seeking information on the availability of facilities and supplies necessary to treat and prevent onward infection from a suspected index case of human H5N1 infection. They were specifically asked about side rooms for isolation and supplies of FFP3 masks, lysis buffer and oseltamivir (Tamiflu).
