Carbon dioxide response curves at altitude.
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Acetazolamide↗
Biomedical subjects
D Sinclair
Publications and source records attributed to D Sinclair.
A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries.
Facial fractures are common in the multiply-traumatized patient, and the results of previous studies that have examined the relationship between facial fractures, cervical spine injuries, and head injuries have produced conflicting results. A retrospective review of 1,050 blunt-trauma patients during a 40-month period at a regional trauma unit revealed 168 patients with facial fractures. The average injury severity score (ISS) of these patients with facial fractures was 31 compared with an average ISS of 25.6 for the entire group. There were 266 facial fractures in these 168 patients: mandible (n = 72), maxilla (n = 74), zygoma (n = 52), orbital (n = 46), nasoethmoidal (n = 20), and frontal (n = 2). There were seven (4%) cervical spine injuries, three of which were atlanto-occipital subluxations in patients who ultimately died. Of the four surviving patients, one had a cord injury. In contrast, 145 (85%) showed evidence of head injuries; 64 (38%) of these head injuries were serious and 17 of these patients required craniotomy. The relationship of facial fractures and cervical spine injuries may be over emphasized; head injuries, although frequently minor, are much more commonly associated with facial fractures.
Adolescent↗
Prehospital cardiac arrest survival and neurologic recovery.
Many studies of prehospital defibrillation have been conducted but the effects of airway intervention are unknown and neurologic follow-up has been incomplete. A non-randomized cohort prospective study was conducted to determine the effectiveness of defibrillation in prehospital cardiac arrest. Two ambulance companies in the study area developed a defibrillation protocol and they formed the experimental group. A subgroup of these patients received airway management with an esophageal obturator airway (EOA) or endotracheal intubation (ETT). The control group was composed of patients who suffered a prehospital cardiac arrest and did not receive prehospital defibrillation. All survivors were assessed for residual deficits using the Sickness Impact Profile (SIP) and the Dementia Rating Scale (DRS). A total of 221 patients were studied over a 32-month period. Both the experimental group (N = 161) and the control group (N = 60) were comparable with respect to age, sex distribution, and ambulance response time. Survival to hospital discharge was 2/60 (3.3%) in the control group and 12/161 (6.3%) in the experimental group. This difference is not statistically significant. Survival in the experimental group by airway management technique was basic airway support (3/76 3.9%), EOA (3/67 4.5%), and ETT (6/48 12.5%). The improved effect on survival by ETT management was statistically significant. Survivors had minor differences in memory, work, and recreation as compared to ischemic heart disease patients as measured by the SIP and DRS. No effect of defibrillation was found on survival to hospital discharge. However, endotracheal intubation improved survival in defibrillated patients. Survivors had a good functional outcome.
Aged↗
Emergency department triage: a program assessment using the tools of continuous quality improvement.
An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff job descriptions, organization charts, orientation manual, and physical facilities was conducted. A chart audit was completed on 100 triage notes. Direct observation was undertaken on nine occasions. An evaluation of the data gathered was performed using the tools of continuous quality improvement, and resulted in specific recommendations being made to improve the process of care. It was concluded that emergency medical attendants function very well in an emergency medicine triage system and the tools of continuous quality improvement can be applied to a clinical service to improve the quality of care.
Clinical Competence↗
Emergency physicians versus laboratory technicians: are the urinalysis and microscopy results comparable? A pilot study.
In the literature to date, there are no studies that directly evaluate microscopic urine examination results obtained by a physician compared to those of a trained laboratory technician. Our purpose in undertaking this study was to determine whether there would be comparable results obtained by these two groups. The study took place in an Emergency Medicine Department with 45,000 visits annually. Each urine sample obtained on patients presenting to the Emergency Department was divided into two lots: one was sent to the laboratory and the other was analyzed by the emergency physician. A comparison of both dipstick and microscopic results by physician and laboratory staff was then made using sensitivity, specificity, and Kappa analysis. Statistical analysis of the data revealed close agreement between the emergency physician and laboratory technician with respect to the following components of urinalysis: red blood cell urinalysis and microscopy, leukocyte esterase, and nitrite testing. Microscopy for white cells and bacteria and testing for proteinuria were not in close agreement. Urinalysis by emergency physicians is comparable to laboratory technicians for a number of the testing components. However, in this limited pilot study, emergency physicians were not able to consistently perform urinalysis for the laboratory standard.
Adolescent↗
Effects of adrenaline on coronary flow in isolated perfused rat hearts.
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Adenosine Triphosphate↗
Audit of inhaled asthma therapy.
The problems patients experience with inhaled asthma therapies are well documented. In an attempt to overcome these, the British Thoracic Society investigated the expansion of the respiratory nurse specialist's role to cover some of the more problematic areas of deficiency. In preparation for this expansion, the authors carried out an audit on 100 adults attending an asthma clinic. It established that more than half of the patients did not use their inhaler devices properly, and indicated which groups and skills required intervention from the respiratory nurse.
Administration, Inhalation↗