Desktop system for accounting, audit, and research in A&E.

The development of a database for audit, research, and accounting in accident and emergency (A&E) is described. The system uses a desktop computer, an optical scanner, sophisticated optical mark reader software, and workload management data. The system is highly flexible, easy to use, and at a cost of around 16,000 pounds affordable for larger departments wishing to move towards accounting. For smaller departments, it may be an alternative to full computerisation.

Doppler measurement of cardiac output during cardiopulmonary resuscitation.

OBJECTIVE: To estimate the cardiac output produced by external cardiac compression during standard cardiopulmonary resuscitation performed by two groups of operators with different levels of experience and training. METHODS: Cardiac output was measured by Doppler aortovelography. All patients included in the study had necropsy examinations. Only patients without evidence of pulmonary embolism, myocardial rupture, aortic valve disease, or acute depletion of the intravascular volume were included. RESULTS: 31 patients presenting to the accident and emergency department suffering from non-traumatic cardiac arrest had cardiac output measurements made during resuscitation. Eleven patients were excluded after necropsy examination. The median cardiac index for the 20 study patients was 3.2 L min-1 m-2. The cardiac output produced by massage by less experienced personnel (median 1.2 L min-1 m-2) was significantly less than that produced by those fully trained in the technique (median 3.2 L min-1 m-2; P < 0.01 95% confidence interval -2.36 to -1.29). The amount of resuscitation related trauma was no greater than in other published series. CONCLUSIONS: Differences in cardiac output during external cardiac compression are related to experience with the technique.

Treatment of knee sprains: modified Robert Jones or elastic support bandage?

The aim of this investigation was to compare in a prospective randomized study the outcome of painful, traumatic knee injuries when treated with either the modified Robert Jones (MRJB) or elastic support bandage (ESB). Patients with moderate or severe unilateral knee injury presenting to our department within 24 h were randomized into two treatment groups receiving either the MRJB or an ESB. The main outcome parameters of the study were the amount of pain relief required, the speed of recovery, mobility and patient preference. The results of our study of 40 patients indicate that the two treatments were equally effective in treating knee sprains, and patients preferred the ESB in the early post-injury period. Therefore, we see no reason to continue using the MRJB for the treatment of sprained knees in the accident and emergency (A&E) setting when a more patient acceptable, time and cost-effective treatment is available.

A computerized prospective audit of cardiopulmonary resuscitation in the accident and emergency department.

A prospective survey of cardiopulmonary resuscitation is in progress in the Accident and Emergency Department of the Royal Hallamshire Hospital. During the 12 months from January 1985 to January 1986, 123 cardiac arrests were treated in the accident department. Ninety of these arrests occurred outside the hospital; nine of these patients survived to leave hospital. Of the 33 people arresting in the department, 10 survived to leave hospital. The causes of death are presented.

The hands of karate experts. Clinical and radiological findings.

The hands and wrists of 22 karate instructors who had practiced the sport for a minimum of five years were reviewed. Radiological evidence of a total of ten fractures was found. There was no evidence that practice of the sport predisposed to the early onset of chronic tenosynovitis or osteoarthritis.

A controlled trial of different treatment regimens in patients with urinary tract infections after lower urinary tract surgery.

One hundred and four patients who developed urinary tract infections after catheterization for acute retention of urine and surgery of the bladder or urethra were randomly allocated to four treatment groups. Analysis of the results in 65 patients showed that co-trimoxazole and 1 g cephradine administered twice daily for 1 week were successful in eradicating the urinary tract infections in 93% and 88% of the patients, respectively. The same dose of cephradine administered 4-times a day eradicated 64% of the infections. In patients for whom no treatment was given, the original infection did not clear in 65%. Escherichia coli and coagulase-negative staphylococci were the commonest infecting organisms. The in vitro sensitivity testing of antibiotics did not correlate well with the successful eradication of the infecting organism.