Referral to the accident and emergency department following the use of community alarms.

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.

Review of a computer based telephone Helpline in an A&E department.

OBJECTIVE: An audit of use of the telephone Helpline in the accident and emergency (A&E) department was conducted to establish the type of call, time, by whom the calls were made, appropriateness of advice given, and whether callers attended or not as advised, and also to obtain feedback from callers as to the degree of satisfaction with the advice given. METHODS: All calls over a four week period were included in the study. The information logged comprised name, age, telephone number, date and time of call, nature of query, advice given, and name of advisor. Callers whose telephone number had been noted were contacted for feedback. RESULTS: There were 300 calls over the four week period, and 150 callers were available for feedback. Most calls were received between 12.00 and 20.00 hours. The majority of callers were parent or self, 52% of calls were for problems concerning adults, and 40% for children; no age was recorded in 8%. Nursing staff answered 90.7% of the calls. Queries were wide ranging but commonly involved open and closed wounds and head injuries, with 29.3% being advised to attend A&E, 32.3% to ring or see their GP, and 38.4% were reassured or given other advice; 4% of callers attended A&E despite being advised otherwise, 97% were judged to have received appropriate advice, and 91.3% of callers were satisfied with the advice given. CONCLUSION: The Helpline has proved of benefit to the public. It is necessary and important to have protocols for common problems and to document all details carefully. It is also necessary that nursing staff are trained in handling the telephone queries and using the protocols. The use of a PC based system has improved data collection and also allows immediate access to protocols.

A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose.

The aim of this prospective trial was to compare the efficacy of gastric lavage, activated charcoal and ipecacuanha at limiting the absorption of paracetamol in overdose and to assess the significance of the continued absorption of paracetamol following treatment. Patients aged 16 and over who had ingested 5 gms or more of paracetamol within 4h of admission were entered into the trial. The percentage fall in plasma paracetamol level was used as the measure of the success of a treatment at limiting absorption. The mean percentage fall was 39.3 for gastric lavage, 52.2 for activated charcoal and 40.7 for ipecacuanha, with a significant difference between the treatment methods (p = 0.03). Activated charcoal was more effective at limiting the absorption of paracetamol following overdose than either gastric lavage or ipecacuanha induced emesis. In treated patients continuing paracetamol absorption is not significant if more than 2h have elapsed since ingestion.

Interscalene brachial plexus blocks in the management of shoulder dislocations.

Interscalene brachial plexus block is a simple and effective alternative to intravenous benzodiazepines or general anaesthesia for manipulation of the dislocated shoulder. Thirty interscalene brachial plexus blocks were performed on 29 patients with dislocations of the shoulder to provide regional anaesthesia for reduction. Pain was abolished by 14 out of the 30 blocks performed, improved by 13 and unchanged by three. Muscle relaxation (MRC grade 3 or less) occurred in 21 patients. In 26 cases the block allowed reduction of the dislocation without additional analgesia or sedative. Reduction was not possible in four cases. There were no significant complications.

A review of trauma deaths in an accident and emergency department.

There were 56 deaths following trauma in the adult Accident and Emergency Department of the University Hospital, Nottingham, over a 5-year period from 1983 to 1987. Forty-six of these deaths followed road-traffic accidents. The trauma deaths made up 16% of all adult deaths and 0.13 per thousand new attenders. We found evidence of inappropriate management in four cases, all relating to inadequate volume replacement. In two patients, the degree of hypovolaemia was not appreciated and in the other two, volume replacement was not commenced within 30 min of arrival in the department. Prompt treatment of hypovolaemic shock with appropriate fluids in adequate quantities cannot be overemphasized.

Femoral nerve block for analgesia in fractures of the femoral neck.

The purpose of this study was to investigate the efficacy of femoral nerve blocks in patients with fractures of the neck of the femur. Thirty-six patients with femoral neck fractures attending the accident department over a three month period received femoral blocks from one of the two authors. The effect of the block was assessed both subjectively and objectively. Thirty patients reported a worthwhile reduction in pain following the procedure and this was supported by objective blockade in 29. In all six patients who reported no benefit, the block failed objectively. There were no complications of the procedure.