ABSTRACT
BACKGROUND: Stroke thrombolysis is strongly supported as an effective therapy for selected cases of early stroke. The absence of 24 h stroke specialists in district general hospitals (DGHs) has led to the suggestion that regional hyper-acute stroke centres should be developed. This paper describes a cooperative model that uses the skills already present in a DGH to deliver a thrombolysis service initiated in the emergency department by the emergency physicians, and describes the outcomes of that service in comparison with the SITS-MOST trial. METHOD: The outcomes of all stroke patients thrombolysed at Scarborough DGH from 2004 to January 2009 were reviewed. Outcome was defined using a three-part scale. Data at Scarborough DGH were compared with data from the SITS-MOST European-wide study of stroke thrombolysis. RESULTS: Data were available for 98 of 110 patients thrombolysed during the study period. Fifty (51%) had a good outcome, seven (8%) had partial resolution of their symptoms, and 41 (42%) showed no improvement or deterioration. These outcomes were comparable to those in the European database. CONCLUSION: Stroke thrombolysis can be effectively delivered in a non-specialist (a non-hyper-acute stroke centre) DGH in the UK. An audit of cases completed describes complications seen.
Subject(s)
Emergency Service, Hospital , Fibrinolytic Agents/therapeutic use , Stroke/drug therapy , Thrombolytic Therapy , Adult , Aged , Aged, 80 and over , England , Female , Hospitals, General , Humans , Male , Middle Aged , Outcome Assessment, Health CareABSTRACT
Acute compartment syndrome after muscle rupture, although rare, is a limb threatening condition, which warrants emergency treatment. The case of acute compartment syndrome secondary to a gastrocnemius muscle tear of the right lower leg, in a non-athlete is reported. To our knowledge, this is the only description of acute compartment syndrome due to muscle rupture in a non-athlete.
Subject(s)
Compartment Syndromes/diagnosis , Compartment Syndromes/etiology , Emergency Treatment/methods , Muscle, Skeletal/injuries , Accidents, Occupational , Acute Disease , Agriculture , Compartment Syndromes/surgery , Humans , Leg , Male , Middle Aged , RuptureABSTRACT
The risk factors affecting intracranial haemorrhage in warfarinised patients are described and an attempt made to calculate the risk of haemorrhage in warfarinised patients with minor head injuries. Using the data from studies of patients with spontaneous haemorrhage while taking warfarin, guidelines for treatment and given and the likely outcome predicted.
Subject(s)
Anticoagulants/adverse effects , Cerebral Hemorrhage/chemically induced , Craniocerebral Trauma/therapy , Warfarin/adverse effects , Aged , Anticoagulants/administration & dosage , Atrial Fibrillation/etiology , Atrial Fibrillation/prevention & control , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/epidemiology , Craniocerebral Trauma/complications , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Injury Severity Score , Male , Middle Aged , Prevalence , Prognosis , Risk Assessment , Survival Rate , Thromboembolism/etiology , Thromboembolism/prevention & control , Tomography, X-Ray Computed , United Kingdom/epidemiology , Warfarin/administration & dosageABSTRACT
In a retrospective review of 16 years of admissions to a regional cardiothoracic unit, 76 patients were admitted with stab wounds to the chest. Of these wounds, 75% were managed conservatively with tube drainage and observation and 25% required surgical intervention. 5.2% were managed as emergency room thoracotomies, 15.8% as urgent procedures in the operating theatre and 4% as late procedures. The total mortality was 1.3% and was seen in the emergency room thoracotomy group (mortality 25%). The risk if sub-diaphragmatic injury in the presence of chest injury is highlighted.
Subject(s)
Thoracic Injuries/therapy , Wounds, Stab/therapy , Adolescent , Adult , Chest Tubes , Emergencies , Female , Humans , Male , Middle Aged , Retrospective Studies , Thoracic Injuries/mortality , Thoracic Injuries/surgery , Thoracotomy , Wounds, Stab/mortality , Wounds, Stab/surgeryABSTRACT
Sarin is now a weapon of the terrorist. Its acute effects are primarily due to unrestricted cholinergic activity at both muscarinic and nicotinic receptors. Treatment is based on the use of large doses of atropine and pralidoxime which may lead to practical problems of sufficient drug supplies for the average hospital. Ventilation may be necessary and present problems. Victim decontamination involves use of bleach, soap and water. Staff handling casualties need protection with respirators and butyl rubber boots and gloves.
Subject(s)
Sarin/poisoning , Violence , Guidelines as Topic , Humans , Poisoning/diagnosis , Poisoning/drug therapy , Poisoning/physiopathology , PrognosisABSTRACT
A new scale for the repeated, rapid assessment of mental function in patients with subarachnoid hemorrhage is described. Its reproducibility is evaluated and early experience with its use in the intended clinical setting is reported. The test (Maudsley Mentation Test) proved to be more sensitive to fluctuations in cerebral functioning than existing measures of conscious level, and the results were reproducible among observers with different backgrounds (surgeons, nurses, and psychologists). The results suggest a relationship between performance on mentation testing and quality of outcome. The Maudsley Mentation Test is thought to offer a suitable measure with which to monitor patients during the acute phase of their illness to supplement clinical assessment and provide evidence of deterioration at an early stage. It is also potentially useful as an end point in acute protection and treatment studies.
