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Biomedical subjects

A W Wilson

Publications and source records attributed to A W Wilson.

At least 37 records · Page 2Linked to original sources
PubMed1996

Survival following pre-hospital arrest with on-scene thoracotomy for a stabbed heart.

A 34-year-old man was stabbed in the heart with the loss of all signs of life at the site of the incident. A resuscitative thoracotomy was performed at the roadside rather than transport a lifeless patient to hospital. Thoracotomy revealed asystole, pericardial tamponade and a right ventricular stab wound. Following further roadside resuscitation and subsequent air transport, and 30 min after loss of signs of life the patient was defibrillated in hospital and regained sinus rhythm. He recovered and was discharged at 25 days with normal neurology and mentation. Pre-hospital thoracotomy on a patient who had lost signs of life following a penetrating chest wound is an alternative to a "scoop and run' policy.

Adult↗
PubMed1996

Children falling from a height in London.

OBJECTIVES: To determine the frequency and geographical distribution of children falling from a height in London and to suggest possible causes and preventative measures. METHODS: All relevant cases attended by the Helicopter Emergency Medical Service (HEMS) in a three and a half year period were reviewed and the locations related to the boroughs. The rates, per 1,000 resident children, were compared with socioeconomic indices for the boroughs concerned. In addition, a survey was undertaken of window fittings and maintenance in high rise flats close to one particular incident. RESULTS: A total of 90 incidents were attended involving 91 patients (64 male, 27 female) of whom five died. HEMS attends approximately one third of incidents involving serious trauma. In the study period the maximum frequency was 0.2 fallers per 1,000 resident children, occurring in three boroughs. In three boroughs there were no fallers. There was no overlap in socioeconomic indices between the five boroughs with the highest fall rates and the five with the lowest. The building survey found a high incidence of faulty window catches, a slow response rate for repair, and a lack of safety advice for residents. CONCLUSIONS: The frequency of falling is related to urban deprivation, poor maintenance, and lack of safety information. A combination of regulation and targeted education could substantially decrease deaths and injuries in children from this cause.

Accidental Falls↗
PubMed1995

Pre-hospital management of patients with severe thoracic injury.

The physiological variables of oxygen saturation, blood pressure and pulse rate were compared in the pre-hospital phase and on arrival at hospital in a group of 63 patients with severe chest injury. Eighty-nine pre-hospital thoracic drainage procedures were carried out. Pre-hospital Advanced Trauma Life Support (ATLS) was associated with a significant improvement in all three variables. Median oxygen saturation increased by 17 per cent (P < 0.001), median blood pressure increased from 90 to 120 mmHg (P < 0.001) and median pulse rate decreased from 125 to 105 (P < 0.001). Pre-hospital intervention is indicated for tension pneumothorax, and contraindicated for haemothorax without respiratory compromise. In other situations further evidence is required, and standard ATLS protocols should be used until this is available.

Adolescent↗
PubMed1994

Blood pressure changes in head-injury patients during pre-hospital anaesthesia with propofol.

Intubation at the site of accident is often necessary for patients who have sustained significant head injuries. Propofol can attenuate the hypertensive response to intubation, and cause hypotension in anaesthetic doses which can be greatly exaggerated in hypovolaemic patients. We studied nine patients with isolated head injuries and 11 multiply injured patients with associated head injuries. Patients were resuscitated and then intubated with a small dose of propofol, titrated to ensure unconciousness, and then suxamethonium. In neither group was there a statistically significant fall in blood pressure afterwards although the multiply injured patients tended have greater falls. We conclude that propofol used thus does not cause clinically important hypotension in these potentially unstable patients, but only doctors with suitable anaesthetic and pre-hospital experience should attempt it.

Blood Pressure↗
PubMed1993

Helicopter Emergency Medical Service operating from the Royal London Hospital: the first year.

The additional workload on the support hospital created by using a helicopter for emergency trauma has been assessed in the first year of operation. A total of 135 patients were brought to the Royal London Hospital, of whom 30 died, 34 were transferred for convalescence or rehabilitation to another hospital, and 71 discharged home. The median Injury Severity Score was 17 (range 0-75) and 82 patients (60.7 per cent) had a reduced Revised Trauma Score at the scene. Blunt injury greatly outnumbered penetrating trauma (117 versus 15 patients). Accidental injuries accounted for 77.0 per cent of the total, self-inflicted wounds 14.1 per cent and assaults 8.9 per cent. Parameters employed to assess workload were hospital bed-days used (total 2361), operations (118, occupying 287 h of theatre time) and blood transfusion (total 702 units used). The second 6-month study period showed a considerable increase in the number of patients admitted (102 versus 33) because of increased efficiency in call-out procedures.

Adolescent↗
PubMed1993

On-scene medical decision making and overtriage.

This study examined whether a hospital-based helicopter trauma service led to 'overtriage' of patients back to the multispecialty base hospital. All accident-site triage decisions made during 1991 were studied. Seven of the 574 decisions (1.2 per cent) led to inappropriate movement of the patient to a specialist centre. Twenty-six decisions (4.5 per cent) were based on mechanism of injury alone and the possibility of overtriage by this method is discussed. A trained doctor can select the correct destination for a patient with trauma without inappropriately using the base hospital in preference to local centres.

Air Ambulances↗
PubMed1993

Prehospital surgical airway management: 1 year's experience from the Helicopter Emergency Medical Service.

Advanced Trauma Life Support requires surgical airway techniques to be used in patients when oral or nasal intubation is impossible or contraindicated. Few reports have examined the results of surgical cricothyroidotomy in prehospital trauma management. During a 12-month period, 600 patients were seen and treated by the Helicopter Emergency Medical Service medical team. Advanced airway techniques were performed at the scene in 143 cases (24 per cent). Of these cases, orotracheal intubation was performed in 132 (92.3 per cent) and surgical cricothyroidotomy in 11 (7.7 per cent). The indications for cricothyroidotomy were: (1) failed intubation in patients with facial injuries, (2) intubation impossible due to patient position during entrapment, and (3) severe burns. Four patients, who were already in cardiopulmonary arrest, succumbed in the field despite cricothyroidotomy. Three patient later died in hospital and four (37 per cent) survived. Three of the survivors made a good recovery, including one who was in cardiorespiratory arrest at the scene, and one remains severely disabled. Surgical cricothyroidotomy is a life-saving procedure in prehospital trauma management that must be performed without delay or hesitation if conventional airway manoeuvres are impossible or fail.

Adult↗
PubMed1993

Role of the beta subunit in determining the pharmacology of human gamma-aminobutyric acid type A receptors.

A cDNA encoding the human gamma-aminobutyric acid (GABA)A receptor beta 2 subunit has been cloned and sequenced. The deduced amino acid sequence of this cDNA shows only a single amino acid change from the rat sequence (Asn-347 in rat, serine in human). Using polymerase chain reaction amplification of human-specific products from human x rodent somatic cell hybrid DNAs, the gene has been assigned to human chromosome 6. By expressing recombinant human GABAA receptors containing different beta subunits (beta 1, beta 2 or beta 3) in both transfected cells and Xenopus oocytes, we have been able to determine the influence of the beta subunit on the pharmacology of the receptor. For a number of benzodiazepine binding site compounds, a barbiturate, and several neurosteroids, neither the affinity nor the efficacy of the compounds is influenced by the type of beta subunit present in the receptor molecule. These data suggest that the beta subunit does not significantly influence the benzodiazepine, barbiturate, or steriod site pharmacologies of human GABAA receptor subtypes.

Amino Acid Sequence↗
PubMed1992

The Royal London Hospital Helicopter Emergency Medical Service: first phase 1990.

A Helicopter Emergency Medical Service (HEMS) has been introduced to improve trauma care in the Southeast of England. The majority of the workload comes from the area bounded by the M25 ring road. In 1989 a Dauphin 365N helicopter equipped for pre-hospital primary rescue and emergency inter-hospital secondary transfer was certified by the Civil Aviation Authority. The helicopter commenced carrying patients with a paramedic and a doctor on board early in 1990. In September 1990 this service was further improved by the opening of a helipad at the Royal London Hospital and a designated HEMS desk at London Ambulance Service central control. Eighty-four patients were transported in primary rescue missions and 107 as emergency transfers in 1990.

Aircraft↗
PubMed1990

Psoriatic arthropathy of the temporomandibular joint.

A case of psoriatic arthritis of both temporomandibular joints is described with a brief review of the literature and discussion on the management of this condition. To date, psoriatic arthritis has been successfully treated by conservative means. In the case reported, surgical replacement of the condyles became necessary to eliminate pain and restore function.

Adult↗
PubMed1990

Combined use of Doppler and conventional ultrasound for the diagnosis of vascular and other lesions in the head and neck.

Twenty-three patients with swellings of the head and neck were prospectively investigated by Doppler ultrasound and ultrasound imaging to determine the type and vascularity of the lesions and thereby aid pre-operative diagnosis. Four vascular lesions were correctly identified while vascularity was not found in patients with lipoma, cysts, abscess, or muscular hypertrophy. Increased vascularity was found in or near some tumours and lymphangiomas, but by careful comparison of findings these lesions were not confused with true vascular lesions. The value of the investigations was demonstrated by a change in the treatment in 6 of the cases in this series.

Abscess↗
PubMed1990

Estimated fetal weight in twin pregnancy: how good are we?

Ultrasonic assessment of fetal weight derived from multiple measurements of the fetus has become accepted in clinical practice as being useful in singleton pregnancies. Several different formulae for estimating fetal weight have been derived from differing measurements of the fetus, such as biparietal diameter, trunk circumference, and femur length. To date, there has been no attempt to evaluate such a technique in multiple pregnancy. This study aims to see whether the formulae derived for singleton pregnancy are applicable to twin pregnancies. Estimated fetal weight will be derived by mathematical modelling from ultrasonic measurements made within a week of delivery and the results compared with the actual birthweight to give an indication of how good such estimated fetal weights are. Factors to be considered in the analysis include whether there are differences between Twin I and Twin II, differences of presentation with twins and differences by gestation at delivery.

Birth Weight↗
PubMed1987

The effect of weight loss, operation and parenteral nutrition on fat clearance in patients with colorectal cancer.

1. Fractional fat clearance rate (K2) in 21 patients with colorectal cancer was studied using the intravenous fat tolerance test. 2. K2 showed a negative correlation with weight change (r = -0.736, P less than 0.001) with the tumour in situ. 3. Fourteen patients were retested 12 weeks after curative resection of their tumours. Eight of the fourteen patients had raised K2 values pre-operatively; in all these the K2 values were reduced post-operatively (pre-operative median 3.94%/min, range 2.63-7.20%/min, post-operative median 2.31%/min, range 1.57-5.36%/min, P less than 0.01 by Wilcoxon's signed rank test). A high pre-operative K2 value was associated with a large reduction in K2 post-operatively (r = -0.844, P less than 0.001). 4. Seven patients with relatively high K2 values received a pre-operative course of intravenous nutrition after which K2 values were significantly reduced (pre-feeding median 7.20%/min, range 4.72-12.12%/min, post-feeding median 4.44%/min, range 2.17-6.83%/min, P less than 0.05).

Aged↗
PubMed1986

Bone scintigraphy in the management of X-ray-negative potential scaphoid fractures.

One hundred and eleven patients with signs and symptoms of carpal scaphoid injury, but with no fracture visible on X-ray, underwent bone scintigraphy of the wrists. The first 42 patients were re-X-rayed 10 days after injury: bone scanning had identified all fractures confirmed on this X-ray; there were no false negative bone scans. Sixty-seven patients (60%) did not have increased focal uptake over the scaphoid or distal radius, and were mobilised immediately. None of these had a fracture at follow up. Twenty-nine patients with increased uptake over the scaphoid area (26%) remained in plaster of Paris for 6 weeks. All of these had clinical signs of a scaphoid injury. Bone scanning is a practical investigation for all X-ray-negative potential scaphoid injuries, and is acceptable to patient and clinician. In the presence of a normal scan, the practice of re-X-raying patients 10 days after injury may be abandoned.

Adult↗