Women attending an accident and emergency department after assaults.

Assaults on women are a distressing aspect of A&E work. In a combined prospective and retrospective study, covering a 6-month period, 282 female victims were identified (0.75% of attendances). Although most of the injuries were relatively minor the recording of historical and social factors was poor. Attempted follow up for counselling and support proved ineffective. Better education of the doctors regarding the documentation for such patients, assessment of the social dimensions of their needs and requirement for improving both their immediate care and long term follow-up are discussed.

Puncture wounds of the foot: can infective complications be avoided?

The bacteriological flora of the foot and shoe was studied concurrently in 200 volunteers without foot injuries, and 80 patients with puncture wounds of the foot. Seven of 28 child patients developed clinical infections, three with Pseudomonas aeruginosa. Eleven of 52 adult patients also developed infections. No patients developed infection if oral antibiotics were given within the first 24 h after injury (P < 0.05). Oral antibiotic prophylaxis is recommended for puncture wounds of the foot.

The management of dental problems presenting to an accident and emergency department.

Patients with dental diagnoses, not necessarily traumatic, often present to accident and emergency departments and general medical practitioners. Few doctors have received much, if any, education in the management of these patients. A 6 month prospective study revealed 107 patients (0.3% of new attenders) attending the accident and emergency department of Glasgow Royal Infirmary. Only 19 of these had suffered trauma. Medical staff in the department were only rarely able to make any diagnosis, and management of these patients took place on an empirical, symptomatic basis. Management could be improved by better education of medical students and doctors. Use of an algorithm may be appropriate.

Intravenous drug abusers attending an inner city accident and emergency department.

In a 3-month prospective study, intravenous drug abusers represented 1.14% of all new attendances at Glasgow Royal Infirmary. They generated a significant workload and were often difficult to identify. A very high proportion required surgery or other invasive procedures. The clinical and epidemiological characteristics of the patients were often unexpected. The risks to staff and other implications for the A&E department are discussed.

Use of the emergency ambulance service to an inner city accident and emergency department--a comparison of general practitioner and '999' calls.

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a '999' call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.

The general practitioner's use and expectations of an accident and emergency department.

In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.