Fifteen consecutive patients who had been resuscitated from cardiac arrest and transferred immediately to an Intensive Care Unit were studied. Measurements of intraarterial pressure, cardiac output and systemic vascular resistance demonstrate that 'cuff' blood pressure may not always be related to intraarterial pressure or cardiac output and cannot be used for diagnostic, therapeutic, or prognostic purposes. Following resuscitation, a palpable pulse was present in each of these patients, but did not correlate with adequacy of cardiac output. Too often we hear during a cardiac arrest the question 'Does the patient have an output?', when we should really be asking 'Does the patient have a pulse?'. The palpation of a pulse is a simple and important indication of spontaneous cardiac activity. However cardiac output must be measured and it's adequacy cannot be inferred from this basic clinical measurement.

Aged↗

PubMed1990

The work of the South Manchester Accident Rescue Team (SMART).

Skills acquired in the hospital do not necessarily translate to the scene of an accident. However, training in certain hospital specialties, particularly accident and emergency medicine, will expose doctors to dealing with very ill patients in a less rigidly structured environment. The operating theatre is a disciplined and controlled environment. Skill in anaesthesia, monitoring and operating, if tested only in these circumstances may be found to be gravely inadequate when exposed to the fluctuant and hostile environment at the site. Doctors who wish to do this sort of work or are designated to do it, must undergo regular and frequent training, especially if they are not trained in accident and emergency departments. This has long been recognised by the British Association for Immediate Care. In combination with the Royal College of Surgeons of Edinburgh they have now established a diploma in Immediate Medical Care. In urban areas the need for a doctor to attend at the scene of an accident is usually limited to entrapment. These occasions are likely to be infrequent and this can result in a lack of preparedness for such events. Interhospital transfer, primarily from peripheral hospitals to the specialist services of a teaching hospital, often involves critically ill and injured patients. The management of these cases by the mobile team provides regular, frequent exposure to working in a 'hostile' environment. Relationships with the rescue services are developed and staff become familiar with equipment and call-out procedures. The care of transported patients is improved. None of our patients have died in transit or within 6 h of arrival at base.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗

PubMed1990

Alcohol and conscious level.

Many patients presenting to the Emergency Medical Services have recently consumed alcohol. This may profoundly affect their behaviour, conscious level and response to illness and treatment. The blood alcohol level (BAL) is of little use in the evaluation of these responses. Abnormal conscious level should never be ascribed to alcohol intoxication alone. It is only a diagnosis of exclusion. The most commonly associated conditions are head injury, cerebro-vascular incidents, hypoglycaemia and other drug intoxications.

Alcoholic Beverages↗

PubMed1989

Response of the south Manchester accident rescue team to the earthquake in Armenia and the Lockerbie air disaster.

Explore the source record for details and available documents.

Accidents, Aviation↗

PubMed1989

International response to disasters.

Explore the source record for details and available documents.

Disaster Planning↗

PubMed1989

Trauma audit.

Explore the source record for details and available documents.

Humans↗

PubMed1988

Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation.

Oxygen consumption (VO2) immediately following major injury in man has been said to be reduced. The evidence for this is poor. We have therefore measured VO2 soon after major injury in 16 patients. VO2 was reduced in only two patients, within the normal range in four and increased in ten. VO2 was maintained by increased oxygen extraction in six patients leading to low levels of mixed venous oxygen saturation. There is no evidence for an 'ebb phase' response in man.

Adolescent↗

PubMed1988

Trauma audit--the use of TRISS.

The TRISS methodology for evaluating trauma care has been applied in two UK hospitals over a 12 month period. Unexpected deaths occurred in both hospitals and were related to delays in transport between hospitals. The delays were instigated by the receiving hospitals and never the despatching hospital. Unexpected survival occurred in one of the hospitals. The common factors were: 1. Patients were taken there directly and did not require further transfer. 2. They were resuscitated by a consultant. 3. They were electively ventilated. 4. CT Scan excluded a neurosurgical emergency. 5. When surgery was required it was carried out early. 6. They were treated for several weeks in an ICU with 24 hour direct consultant involvement. They all developed septic shock and acute respiratory distress but ultimately made a full recovery. This evidence supports the view that direct transfer of patients to Trauma Centres in the UK is likely to reduce unnecessary deaths. The development of such a system and the location of such centres must be based on objective measures of case mix and performance. We recommend the establishment and development of a Major Trauma Outcome Study (MTOS) (UK).

Diagnosis-Related Groups↗

PubMed1987

Use of the automatic external defibrillator-pacemaker by ambulance personnel: the Stockport experience.

In an attempt to reduce the number of people who die from a cardiac arrest in the Stockport area ambulances were equipped with automatic external defibrillator-pacemakers, and ambulance personnel were trained in their use. Over an 18 month period ambulance personnel attended 113 patients in cardiac arrest with these devices. One patient subsequently survived, and three patients survived for up to three days. The reasons for these poor initial results include the failure of bystanders to provide cardiopulmonary resuscitation, a delay in calling for the ambulance, and too few defibrillators being available.

Allied Health Personnel↗

PubMed1987