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Biomedical subjects

A F Dove

Publications and source records attributed to A F Dove.

At least 19 recordsLinked to original sources
PubMed1997

Effectiveness of ambulance paramedics versus ambulance technicians in managing out of hospital cardiac arrest.

OBJECTIVE: To determine the effectiveness of extended trained ambulance personnel (paramedics) for the management of out of hospital cardiac arrest. METHODS: A retrospective cohort study of patients who suffered a cardiac arrest between 1 January 1992 and 31 July 1994, and who were transported to their local accident and emergency (A&E) department. Data were collected on basic demography, operational time intervals, and ambulance crew status. Further clinical data were collected, and outcome measures included status on arrival at A&E, status on leaving A&E (hospital admission), and status on leaving hospital. The data were analysed using univariate and multivariate techniques. RESULTS: Univariate analysis showed the likelihood of arriving in A&E with a return of spontaneous circulation was more than doubled among patients attended by a paramedic crew compared with those attended by technicians (relative risk = 2.48, 95% confidence interval 1.34 to 4.60). The likelihood of successful hospital admission was also significantly increased (RR = 1.92, 95% CI 1.13 to 3.27); however, beyond this point, further survival benefits appeared to be much smaller. Similar findings were revealed using multivariate analysis. Second level modelling revealed further possible differences between paramedic and technician crews according to type of incident. Patients successfully admitted to hospital who died before discharge remained severely disabled between admission and death. CONCLUSIONS: There are marked short term survival advantages after cardiac arrest associated with paramedic care, but these probably diminish rapidly over time.

Aged↗
PubMed1991

Are accident flying squads also worthwhile for medical emergencies?

A retrospective analysis of 208 flying squad attendances was performed to assess the effect of pre-hospital care by the team on outcome in emergency medical conditions, and in the trauma victim. Sixty-two (26%) of these cases were medical, but only 24 (11.5%) required immediate cardiopulmonary resuscitation. Only one out of the four successful resuscitations finally left hospital alive. In trauma, there was no significant enhancement of survival due to the presence of the team by comparing the expected against observed mortality and the injury severity score for age-matched groups. The value of flying squads as a training aid, perception of the local community and relationships with other emergency services are discussed. Alternative solutions to improving pre-hospital care include advanced trained ambulance and bystander resuscitation schemes. Although difficult to quantify the authors feel that flying squads are of benefit.

Accidents↗
PubMed1990

A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose.

The aim of this prospective trial was to compare the efficacy of gastric lavage, activated charcoal and ipecacuanha at limiting the absorption of paracetamol in overdose and to assess the significance of the continued absorption of paracetamol following treatment. Patients aged 16 and over who had ingested 5 gms or more of paracetamol within 4h of admission were entered into the trial. The percentage fall in plasma paracetamol level was used as the measure of the success of a treatment at limiting absorption. The mean percentage fall was 39.3 for gastric lavage, 52.2 for activated charcoal and 40.7 for ipecacuanha, with a significant difference between the treatment methods (p = 0.03). Activated charcoal was more effective at limiting the absorption of paracetamol following overdose than either gastric lavage or ipecacuanha induced emesis. In treated patients continuing paracetamol absorption is not significant if more than 2h have elapsed since ingestion.

Absorption↗
PubMed1988

Dressings of the nailbed following nail avulsion.

Dressings of the raw nailbed tend to adhere and to be difficult and painful to remove. We have compared three types of dressing: polyurethane sponge, paraffin-gauze and replacement of the finger-nail. Assessment of adherence and pain showed that replacement of the nail had significant advantages over the other dressings.

Adolescent↗
PubMed1987

Antibiotics in open fractures of the distal phalanx?

A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.

Adult↗
PubMed1987

Survival from cardiac arrest in the Accident and Emergency Department.

One hundred consecutive patients who were treated in an Accident and Emergency Department for 'cardiac arrest' were studied prospectively. Of these 30% had arrested within the community, 21% in transit and 49% in hospital. The immediate outcome was that 40 left the A&E Department alive; of these, 13 left hospital alive. The 'survivors' included 3 cases of documented asystole. Patients who were over the age of 65, who arrested out of hospital and at night, were found to have a poor prognosis. The time between arrest and arrival of the ambulance was found to affect outcome. Patients with ventricular fibrillation had the best prognosis and those with electromechanical dissociation the worst.

Aged↗
PubMed1986

Elderly patients in the accident department and their problems.

During two months in the winter and two in the summer information was gleaned about all patients aged 70 and over attending a large accident and emergency department. Comparative figures for the same periods over the previous 20 years showed an increasing number of elderly attenders, the increase being closely related to the increasing proportion of elderly in the population. Using national census data, attendance rates were shown to increase dramatically with age. With increasing age more elderly attended as a result of accidents in the home. The information suggested that social isolation and paucity of support in the community may be responsible for the decision to come to hospital rather than to consult the general practitioner. The elderly attend accident and emergency departments for a wide range of problems but some do so solely for socioeconomic reasons and are particularly difficult to help.

Accidents, Home↗
PubMed1986

Cardiac contusion in patients wearing seat belts.

The incidence of myocardial contusion in patients wearing seat belts and requiring admission to hospital after road traffic accidents was examined. The criteria used for diagnosing contusion were serial electrocardiograms (ECGs) and estimation of CK-MB isoenzymes using the Isomune-CK (Roche) kit. Nine of the 14 patients (64 per cent) showed evidence of myocardial contusion. We suggest long-term studies to establish the true incidence among patients wearing seat belts.

Accidents, Traffic↗
PubMed1986

A new treatment of stable lateral ligament injuries of the ankle joint.

A support for the treatment of stable injuries of the lateral ligament of the ankle has been designed. One hundred and seventy-five consecutive patients with acute injuries were studied. Unstable injuries were excluded by the use of the radiological anterior stress test. One hundred and forty-four patients with stable injuries were randomly allocated to three treatment groups: double Tubigrip, eversion strapping and the new support. The change in the range of movement was used as an objective measure of improvement. The new support was noticeably better than Tubigrip and eversion strapping.

Adolescent↗
PubMed1986

Multiple rib fractures: transcutaneous nerve stimulation versus conventional analgesia.

We have used transcutaneous electrical nerve stimulation (TENS) to treat the acute pain of rib fractures. The study shows that it is an effective technique, achieving higher subjective pain relief scores by patients when compared with analgesic combinations, and achieving greater increases objectively in arterial oxygen concentrations and peak expiratory flow rates. TENS approaches the ideal analgesic in that it is continuous in effect and the dose is patient regulated. It is recommended as an important adjunct to conventional therapy.

Adult↗
PubMed1986

Data collection from road traffic accidents.

A method of improving information about injuries sustained in road traffic accidents is described. It was achieved by combining data from the police with that from the accident and emergency department in such a way that patient confidentiality was preserved. This improved data base shows that present estimates of the number of injuries sustained on the road are too low and that assessments of their severity are probably inaccurate.

Accidents, Traffic↗
PubMed1986

The urgency distribution of an accident and emergency department's workload.

The perceived urgency of 2000 consecutive patients attending the Accident and Emergency Department of the Royal Infirmary, Edinburgh, was assessed using a Linear Analogue Scale. Each patient was assessed by the receptionist, the receiving nurse and the treating doctor. The distribution of urgency rating produced for this patient group was shown to be comparable for each status of assessor, and to correlate with other outcome criteria such as admission and referral rates. The linear scale was also shown to correlate with retrospective assessment using a time-guided category scale. The accident and emergency department workload is predominantly of low urgency (90% less than 5 on a 0-10 scale). Older patients tend to have higher urgency ratings than younger patients and those referred by ambulance, either via general practitioner or 999 calls, have similarly higher urgency distributions. This study provides a basis for the development of a guided category scale for functional triage of accident and emergency departments. Other scoring systems have attempted to similarly quantify the medical component of the workload (Coira & Rothstein, 1983; Peel et al., 1962). However, the complexity of many of these scales, together with the difficulty in usage of so many different scales, begs a reappraisal of the overall triage of patients attending the emergency department. The aim of this study was to look at the perceived urgency distribution of patients presenting to the emergency department. We wished to compare the relative assessment of urgency by various levels of treating staff and to compare those assessments with the referral and outcome of these patients to provide the basis for the development of a comparative Triage Scale.

Accidents↗
PubMed1986

The accident department and Age Concern.

Accident and Emergency Departments are increasingly becoming major providers of primary health care to the elderly. The attendance of an elderly person at an Accident Department may be associated with loss of independence and this may lead to admission to hospital. Such admissions, may sometimes, be avoided by the provision of immediate social support in the community. For five years, we have worked with the Age Concern after-care officer who is able to provide such assistance by liaison with the Social Services. To provide longer-term help, she works closely with the community-based Age Concern network. The Community and Social Services, as well as the Hospital-based services, have benefited from her presence.

Age Factors↗
PubMed1985

Head protection for horse riders: a cause for concern.

We report the frequency with which horse riders with a significant head injury present to a large accident and emergency department. We have also recorded details about the use of headwear and conclude that horse-riding is associated with a serious risk of head injury and 'protective' headwear may not always protect.

Adolescent↗
PubMed1984

Inflatable splints--what are they doing?

The pressure to which splints were inflated was measured to determine whether splintage was effective and if vascular complications were likely. The prevalence of their use by the ambulance service was also investigated. The findings indicate that inflatable splints are in common use, and are rarely inflated to pressures likely to cause vascular complications. However, they are extremely inefficient in holding their pressure and rapidly become ineffective as splints. The therapeutic range between effective splinting and risk of complications is narrow and it is recommended that blow-off valves are incorporated into the manufacture of all such devices.

Emergency Medical Technicians↗