RESUMO
This article presents an overview of a partnership between public health teams in two primary care trusts in South East London, their local acute hospital trusts, and crime and disorder reduction partnerships to support the reduction of harm from violence. It discusses recent developments in violence prevention in emergency departments in the UK, and developments around outreach and case management, more common in the USA. It then outlines the elements of the violence prevention project being conducted in South East London.
Assuntos
Serviço Hospitalar de Emergência/organização & administração , Atenção Primária à Saúde/organização & administração , Violência/prevenção & controle , Adolescente , Fortalecimento Institucional , Relações Comunidade-Instituição , Crime/prevenção & controle , Humanos , Relações Interinstitucionais , Londres , Medicina Estatal , Adulto JovemRESUMO
The painful crisis is the commonest acute presentation of sickle cell disease (SCD), yet effective pain control in hospital is often delayed, inadequate and dependent on injected opiates. Intranasal diamorphine (IND) has been used in paediatric emergency departments for management of acute pain associated with fractures, but the analgesic effect is short lived. We evaluated its efficacy and safety when given in combination with intravenous or oral morphine for rapid analgesia for children presenting to our emergency department with painful crisis of SCD. In phase 1, nine patients received IND plus intravenous morphine. In phase 2, 13 received IND plus oral morphine. There was a rapid improvement in pain score; the proportions in severe pain at t = 0, 15, 30 and 120 minutes in phase 1 were 78%, 11%, 0% and 11%, respectively; in phase 2, 77%, 30%, 15% and 0%, respectively. There were no serious side effects and questionnaire scores indicated that children found IND effective and acceptable. IND can be recommended for acute control of sickle pain in children presenting to hospital.
Assuntos
Analgésicos Opioides/administração & dosagem , Anemia Falciforme/complicações , Heroína/administração & dosagem , Dor/tratamento farmacológico , Doença Aguda , Administração Intranasal , Administração Oral , Adolescente , Analgésicos Opioides/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Heroína/uso terapêutico , Humanos , Lactente , Infusões Intravenosas , Injeções Intravenosas , Morfina/administração & dosagem , Morfina/uso terapêutico , Dor/etiologia , Medição da Dor/métodosRESUMO
The novel use of a single injection digital anaesthesia technique in children is described, which was found to be effective.
Assuntos
Anestésicos Locais/administração & dosagem , Traumatismos dos Dedos/cirurgia , Lidocaína/administração & dosagem , Adolescente , Anestesia Local/métodos , Criança , Serviços de Saúde da Criança , Pré-Escolar , Serviço Hospitalar de Emergência , HumanosRESUMO
Quinine remains a reliable treatment for falciparum malaria in most parts of the world. We report recrudescence of imported Plasmodium falciparum malaria following quinine treatment in the context of concurrent phenytoin use. Supported by a subtherapeutic quinine level, we hypothesise that a drug interaction with phenytoin may compromise the efficacy of quinine in the treatment of malaria.
