ABSTRACT
A case report of mobile, right heart thrombus in the accident and emergency (A&E) department is presented. Though frequently associated with major pulmonary embolism, recognition is usually at postmortem examination. Detection of the presence of mobile thrombus in the right heart by early echocardiogram and prompt treatment may be life saving. Surgical or medical treatment options are dependent on local facilities. Early specialist involvement with a contingency plan in A&E departments are advised.
Subject(s)
Heart Diseases/surgery , Pulmonary Embolism/surgery , Thrombosis/surgery , Adult , Disease-Free Survival , Emergency Treatment , Female , Heart Diseases/diagnosis , Humans , Pulmonary Embolism/diagnosis , Thrombectomy , Thrombosis/diagnosis , Time FactorsABSTRACT
OBJECTIVE: Since March 1992, intravenous nalbuphine hydrochloride has been used prehospital by paramedics in the Plymouth area. This study assesses the impact of this intervention. METHODS: A prospective study of the parenteral analgesic requirements of 1000 consecutive patients arriving by ambulance at the accident and emergency (A&E) department of a large district general hospital. Where parenteral analgesia was given in the A&E department but not by ambulance personnel, a questionnaire was sent to the ambulance crew concerned to ascertain the reasons for not having given nalbuphine. RESULTS: Of 1000 consecutive patients arriving by ambulance, 87 (8.7%) had been given parenteral analgesia either prehospital, in A&E, or in both places. Seventy five (7.5%) needed parenteral analgesia in the A&E department, 29 (2.9%) had been given prehospital intravenous analgesia by paramedics, and a further seven (0.7%) had been given parenteral analgesia by a general practitioner (GP). Thus 36 (3.6%) received prehospital analgesia. Ten patients who had been given analgesia by paramedics required no further analgesia in A&E, whereas 51 patients who had not been given prehospital analgesia required parenteral analgesia in the A&E department. CONCLUSIONS: The introduction of nalbuphine for use by paramedics in prehospital care has increased prehospital parenteral analgesia from 1% in 1992 (given by GPs only) to 3.6% in the current study group, and 41% of patients requiring parenteral analgesia received analgesia prehospital. There may be further scope for extending the indications for nalbuphine use by ambulance personnel.
Subject(s)
Analgesics, Opioid/administration & dosage , Emergency Treatment , Nalbuphine/administration & dosage , Chi-Square Distribution , Data Collection , Drug Utilization , Emergency Service, Hospital , Humans , Injections, Intravenous , Pain Measurement , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , United KingdomABSTRACT
OBJECTIVE: To investigate conditions where, after initially negative plain x rays following trauma, there subsequently proves to be fracture, and to explore ways in which the management might be improved. DESIGN: A 16 month prospective study. Patient details were collected from accident and emergency (A&E) review clinics and returns, A&E ward admissions, correspondence from other services, and discussions at a weekly clinicoradiological conference. The inclusion criteria comprised A&E trauma patients with normal initial plain x rays and proven fractures on subsequent imaging for the same patient event. SETTING: A large A&E department seeing 65,000 new attendances per annum with full back up services. RESULTS: 55 cases were identified: 41 fractures were identified on subsequent plain x ray, six on bone scan, six on CAT scan, and two on MRI scan. The commonest regions involved were the wrist, pelvis/hip, ankle/foot, and leg. Follow up had not been arranged at the initial attendance in 17 instances and between two and 135 days were required for definitive fracture recognition. All but nine patients required alteration in treatment because of fracture detection. CONCLUSIONS: Clinical suspicion of fracture at initial A&E attendance should prompt organised follow up even in the face of normal plain x rays. Consideration should be given to alternative imaging techniques which may have a higher resolution than plain x rays. Close corroboration between A&E and radiology departments has benefits in patient care in this group of patients and may lead to a reduction in functional disability and litigation.
Subject(s)
Diagnostic Imaging , Fractures, Bone/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Emergencies , Emergency Service, Hospital , Female , Fractures, Bone/diagnostic imaging , Humans , Infant , Male , Middle Aged , Prospective Studies , RadiographyABSTRACT
Five patients presenting with erythema nodosum to an accident and emergency department are described. Initially they were misdiagnosed as cellulitis, infected insect bites, and minor trauma. Suspicious skin lesions or joint manifestations occurring either alone or especially if in combination should alert the wary clinician to the possibility of erythema nodosum and follow up in a few days may help to confirm the diagnosis.
Subject(s)
Diagnostic Errors , Erythema Nodosum/diagnosis , Child , Diagnosis, Differential , Emergency Service, Hospital , Erythema Nodosum/physiopathology , Female , Humans , MaleABSTRACT
Primary prevention represents the optimum method of virtually abolishing the factors that lead to this injury scenario. Cooperative effort is required on the part of manufacturers, health education authorities and the user. The present situation is unsatisfactory.
