Emergency department drug therapy for status epilepticus in adults.
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Biomedical subjects
Publications and source records attributed to A S Lockey.
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OBJECTIVES: To identify whether the practice of the UK ambulance trusts comply with national recommendations with respect to when ambulance personnel are allowed to recognise death and/or terminate resuscitation attempts in the adult, normothermic, non-traumatic cardiac arrest. METHODS: Questionnaire study of 39 ambulance trusts. RESULTS: At the time of the study (summer 2000), 23 trusts operated separate policies for recognition of death and termination of resuscitation, two had policies for recognition of death alone, two had policies for termination of resuscitation alone, five operated a policy purely for termination of resuscitation attempts after a limited period of CPR, and seven had no protocols other than "the presence of rigor mortis, postmortem staining or injuries incompatible with life". Only eight trusts conformed to the protocols for both recognition of death and termination of resuscitation attempts recommended by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). CONCLUSION: The JRCALC has proposed guidelines for recognition of death and terminating resuscitation attempts in the adult normothermic non-traumatic cardiac arrest. Despite this, there was still considerable variance in the practice of the UK ambulance trusts.
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OBJECTIVE: To investigate the factors which influence decision making by experienced emergency physicians when they decide whether to (a) pronounce 'life extinct' in adult patients with non traumatic cardiac arrest while in the ambulance, or (b) bring them into the resuscitation room in the Emergency Department for further assessment/management. DESIGN: Qualitative study involving semi structured interviews and a focus group. SETTING: Accident & Emergency (A&E) departments in the Yorkshire region. PARTICIPANTS: Fifteen emergency physicians (two clinical fellows, nine specialist registrars and four consultants) working in the Yorkshire region. RESULTS: Six main themes were identified that impacted upon the decision making process: the doctor's past experience, ambulance service issues, prehospital care, patient characteristics, presence and views of relatives, and organisational issues. CONCLUSION: The reasoning behind decisions made when a patient arrives at the Emergency Department in cardiac arrest is multifactorial. Strict guidelines would be difficult to construct since individuals vary in the importance they attach to different factors.
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The purpose of this study was to investigate whether patients attending an A&E department would prefer injection or suppository diclofenac as analgesia if oral medication was contraindicated. Patients presenting to the 'walking wounded' side were asked to fill in a questionnaire indicating their preference. The results showed a strong preference for intramuscular diclofenac. If we wish to prescribe rectal diclofenac, we should be prepared to take into account the patient's wishes first and, if necessary, explain our reasoning.
The need to exclude cervical spine injury ('clearance') in an obtunded patient poses a dilemma. The purpose of this study was to find out the current practices for tackling this situation around the country. A questionnaire was sent to all Intensive Care Units who accept injured patients. There is a great diversity in the management and investigation of these patients. There is clearly a need for a recognised protocol for dealing with this difficult situation. Such a protocol is suggested.
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OBJECTIVE: To determine the value of advanced trauma life support (ATLS) training for medical staff in a major incident situation, based upon performance in a simulated exercise. METHODS: A major incident exercise was used to assess the management of trauma victims arriving in hospital suffering from multiple or life threatening injuries. The effect of ATLS training, or exposure to an abbreviated form of ATLS training, on the management of patients with simulated life threatening traumatic injuries was examined. The treatment offered by medical staff of different grades and varying exposure to ATLS training was compared. RESULTS: Medical staff who had undertaken ATLS training attained a higher number of ATLS key treatment objectives when treating the simulated trauma victims. CONCLUSION: Medical staff who have either undertaken the full ATLS course or an abbreviated form of the course were more effective in their management of the simulated trauma cases.
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