ABSTRACT
OBJECTIVE: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol concentration. METHOD: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination permitted calculation of injury severity scores as per abbreviated injury scale update 1998. Blood alcohol concentrations were obtained from intoxicated patients with consent. RESULTS: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group, 113 had consumed alcohol and blood alcohol intake were obtained for 47. The alcohol group had a higher incidence of head injuries (46 (48%) versus 22 (9%)) with a lower incidence of limb injuries (39 (39%) versus 183 (76%)) than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (chi(2), p<0.001) and there was a significant difference in the injury severity scores (p<0.001, Z = -2.5). In the alcohol group severity and pattern correlated with alcohol concentration at the time of injury. Patients with an alcohol concentration<2 g/l had mostly soft tissue limb injuries (58%), 2-2.5 mostly significant limb fractures (55%), and >2.5 mostly significant head injuries (90%). CONCLUSIONS: Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration.
Subject(s)
Accidental Falls , Alcohol Drinking/blood , Trauma Severity Indices , Wounds and Injuries/etiology , Adolescent , Adult , Arm Injuries/blood , Arm Injuries/etiology , Craniocerebral Trauma/blood , Craniocerebral Trauma/etiology , Ethanol/blood , Fractures, Bone/blood , Fractures, Bone/etiology , Humans , Leg Injuries/blood , Leg Injuries/etiology , Middle Aged , Prospective Studies , Soft Tissue Injuries/blood , Soft Tissue Injuries/etiology , Wounds and Injuries/bloodABSTRACT
Following an increase in the number of patients attending the accident and emergency department because of accidental injection of adrenaline from autoinjector devices prescribed for patients with severe allergic reactions, a review of published reports was undertaken to identify the best form of treatment. Local injection of phentolamine is effective for up to 13 hours after the inadvertent digital instillation of adrenaline.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Epinephrine/adverse effects , Fingers/blood supply , Ischemia/drug therapy , Phentolamine/therapeutic use , Epinephrine/administration & dosage , Humans , Needlestick Injuries/etiology , VasoconstrictionABSTRACT
A case of soft tissue sarcoma in a young person is described. Accident and emergency workers should be aware of this highly malignant group of tumours. Lumps in young people should not necessarily be assumed to be benign without a definite histological diagnosis.
Subject(s)
Emergency Medical Services , Sarcoma/diagnosis , Soft Tissue Neoplasms/diagnosis , Adolescent , Diagnostic Errors , Fatal Outcome , Humans , MaleABSTRACT
OBJECTIVES: To ascertain if A/E SHOs checked inhaler technique in asthmatic patients and the frequency of patient education. DESIGN: Postal questionnaire survey. SUBJECTS A/E SHOs in Northern Ireland and in the Republic of Ireland from January-June 1994. RESULTS: 92 questionnaires were analysed from 25 (71%) hospitals. 61 (66%) SHOs did not check inhaler technique. The main reason given was pressure of work 38 (62%). 32 (33%) and 41 (44%) SHOs had never been shown how to use a turbohaler or a spinhaler respectively. 49 (54%) do not advise regarding the dangers of passive smoking. 29 (32%) do not inform patients of their PEFR. A/E SHOs are often unfamiliar with inhalers and the majority do not routinely check inhaler technique in asthmatic patients. Many aspects of asthmatic patient education are So Often Forgotten Today in the A/E department.
