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Biomedical subjects

R Crawford

Publications and source records attributed to R Crawford.

At least 55 records · Page 3Linked to original sources
PubMed1997

Traumatic pericardial tamponade: relearning old lessons.

Traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more common, early diagnosis of tamponade is important so that life saving treatment can be started. The classical features of tamponade may be modified by hypovolaemia and the presence of associated injuries; acute tamponade may also be precipitated by rapid administration of large volumes of fluid. Pericardiocentesis, while sometimes life saving, is dangerous and of limited value. Echocardiography is limited by availability and operator dependence. A high degree of clinical suspicion in patients with chest injuries, together with close monitoring and reevaluation, particularly during volume replacement, is essential. Four cases are described which presented to the accident and emergency department of Glasgow Royal Infirmary, in three of which there was a significant delay in the diagnosis.

Adult↗
PubMed1997

Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency.

Severe accidental hypothermia in an urban environment is usually associated with drug or alcohol abuse or serious illness in elderly or debilitated patients. In the presence of cardiovascular instability, extracorporeal rewarming by cardiopulmonary bypass is the gold standard of treatment of such patients. Three cases of profound hypothermia with circulatory collapse are presented. Each was successfully resuscitated to a full neurological recovery using this method in an accident and emergency (A&E) department, although one died later of respiratory complications. All three cases had a serum potassium in the normal range at the start of treatment. Where facilities exist, extracorporeal rewarming can be performed in A&E for patients with profound hypothermia and circulatory collapse. Cardiopulmonary resuscitation must be continued throughout the rewarming process.

Alcoholism↗
PubMed1996

Review of emergency thoracotomy for chest injuries in patients attending a UK Accident and Emergency department.

Over a two and a half year period, 25 patients presenting to the Glasgow Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A&E) department and seven (28 per cent) in a fully equipped operating theatre after resuscitation. There were 23 men and 2 women. Twenty-three (92 per cent) had been stabbed, one (4 per cent) had been shot and one (4 per cent) had sustained a blunt injury in a road traffic accident. Eight (32 per cent) patients survived. All survivors had been stabbed and seven were well enough to undergo thoracotomy in theatre. Only one (5.6 per cent) of the patients operated upon in the A&E department survived to discharge, although three (16.8 per cent) survived the initial procedure. Three of four patients survived, in whom the diagnosis of cardiac tamponade was initially missed. Thirteen (76.5 per cent) of the 17 who did not survive had no vital signs on admission. Outcomes may be improved if appropriately trained hospital staff are immediately available and prehospital delays are minimized so that patients arrive sooner with signs of life still present. Ambulance paramedic interventions have little to offer these patients and may worsen the prognosis if they result in delayed transport to hospital. The emphasis placed on diagnosis and treatment of cardiac tamponade in Advanced Trauma Life Support programmes is appropriate and all staff involved in these cases should undergo this type of training.

Adolescent↗
PubMed1996

Effect of electrosurgical technique on wound healing and early complication rate following abdominal dermolipectomy.

Thirty-eight patients with significant weight loss after vertical banded gastroplasty were studied prospectively while undergoing abdominal dermolipectomy to determine if the current intensity used during electrosurgical dissection influenced wound complication rates after this surgery. Patients were assigned randomly to one of two groups: (1) a HI group, in which the electrosurgical current intensity was set at a level that easily allowed coagulation of all vessels smaller than 0.5 mm in diameter or (2) a LO group, in which the current intensity was set at a much lower level that allowed dissection, but required that nearly all visible vessels be ligated separately. A standardized procedure was employed for all patients. The patients in the LO (N = 14) and HI (N = 24) groups were well matched for age, weight history, nutritional parameters, operative times, surgical blood loss, and postoperative hospital stay. The overall complication rates of 36% and 21%, and wound complication rates of 36% and 13% for the LO and HI groups, respectively, were not significantly different. These data indicate that using a relatively high electrosurgical current intensity for dissection during abdominal lipectomy does not result in a higher wound complication rate.

Abdomen↗
PubMed1996

Pitfalls in diagnosis and management of carbon monoxide poisoning.

Five members of one family suffering from carbon monoxide poisoning are described. Three were initially diagnosed as food poisoning cases at another hospital. A high level of suspicion is required to ensure early diagnosis. Indications for hyperbaric oxygen include: loss of consciousness, neurological signs and symptoms other than mild headache, cardiac complications, carboxyhaemoglobin > 40%, and pregnancy.

Adolescent↗
PubMed1996

Critical analysis of an accident and emergency ward.

OBJECTIVES: To describe the work, both qualitatively and quantitatively, of an accident and emergency (A&E) ward, and discuss some of the advantages and disadvantages associated with this ward. METHODS: An observational study was carried out of all patients admitted to the A&E ward of Glasgow Royal Infirmary from 1 January 1992 to 31 December 1992. Epidemiological and management data were collected for all patients admitted. RESULTS: There were 2460 admissions, of which 69% were related to trauma and 45% to head injury; 47% of the patients had consumed alcohol before admission. Accidental trauma was the commonest reason for admission (57%), followed by assault (33%). Ninety two per cent of admissions stayed for less than 3 d, but 33% of the workload was spent on a small number of patients admitted for longer than 7 d. CONCLUSIONS: This A&E ward presents a significant workload, and some of its most serious problems lie with those patients who stay longer than 72 h. The safe and effective use of the ward depends upon it being well resourced, along with the department it serves.

Adolescent↗
PubMed1995

Use of abdominal computed tomography for identifying disseminated fungal infection in pediatric cancer patients.

Disseminated fungal infection (DFI) is an important cause of morbidity and mortality among immunosuppressed patients with cancer. To determine the role of abdominal computed tomography (CT) in the diagnosis and management of DFI, we studied the records of patients treated in a pediatric oncology center over an 11-year period. A total of 35 children had CT findings compatible with fungal abscesses in the liver, spleen, and/or kidneys and had fungal infection confirmed by culture, biopsy, or at autopsy. Patients were treated with antifungal agents (median duration of treatment, 57 days) until fever resolved and repeated CT scans demonstrated that the lesions had disappeared, regressed, or stabilized. The 3-month survival rate was 86%. An additional 29 patients with similar characteristics and risk factors had characteristic CT findings, but DFI was not documented with other procedures. These patients were empirically treated for presumed DFI; their courses and outcomes were similar to those for patients with documented DFI. These results suggest that it is reasonable to make a presumptive diagnosis of DFI for patients with characteristic CT findings and clinical features. With appropriate therapy, the prognosis for pediatric patients with cancer and documented or presumed DFI is good.

Abdomen↗
PubMed1995

Women attending an accident and emergency department after assaults.

Assaults on women are a distressing aspect of A&E work. In a combined prospective and retrospective study, covering a 6-month period, 282 female victims were identified (0.75% of attendances). Although most of the injuries were relatively minor the recording of historical and social factors was poor. Attempted follow up for counselling and support proved ineffective. Better education of the doctors regarding the documentation for such patients, assessment of the social dimensions of their needs and requirement for improving both their immediate care and long term follow-up are discussed.

Adolescent↗
PubMed1995

Pre-hospital cardiopulmonary resuscitation and pneumoperitoneum.

A case is reported of pneumoperitoneum after prolonged ventilation of a smoke inhalation victim at the scene by a fireman using intermittent positive pressure ventilation. The clinical presentation, treatment and aetiology, when associated with cardiopulmonary resuscitation, are discussed. The need for adequate training in the use of resuscitation equipment is emphasized, especially for non-medical staff.

Emergency Medical Services↗
PubMed1995

Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis.

OBJECTIVE: To identify the causes of diabetic ketoacidosis (DKA) in a large urban hospital. RESEARCH DESIGN AND METHODS: Consecutive patients admitted during a 3-month period with a primary diagnosis of DKA and who had moderate-to-severe illness as shown by serum glucose > 13.9 mmol/l ( > 250 mg/dl), bicarbonate < 15 mmol/l, and pH < 7.35 were studied. Diabetes nurse educators interviewed patients and reviewed their medical records for the following: precipitating causes of DKA; content of previous diabetes education; frequency of blood glucose monitoring; recognition of symptoms of metabolic decompensation; and types of medical assistance obtained once patients were ill. RESULTS: There were 56 episodes of DKA, and 75% of the episodes were in patients with known diabetes. In the known diabetic patients, the most common cause of DKA was stopping insulin therapy, which occurred in 67% of episodes. Half of the patients (50%) stopped insulin because of reported lack of money to buy insulin from an outside pharmacy or get transportation to the hospital; 21% stopped insulin because of lack of appetite; 14% stopped insulin because of behavioral or psychological reasons; and 14% did so because they did not know how to manage diabetes on sick days. Of the known diabetic patients, > 80% recalled having been instructed as to blood glucose testing and acute and chronic complications, but fewer patients recalled having been instructed as to insulin dose adjustment (28%) or sick day management (35%). Symptoms of decompensated diabetes were recognized in 55% of the 42 episodes of DKA in patients with known diabetes. However, only 5% of patients contacted the Diabetes Unit when they became ill; the majority (95%) went directly to the emergency room. CONCLUSIONS: DKA occurred most often in patients with known diabetes who stopped insulin therapy because of reported lack of money for purchasing insulin or for transportation to the hospital and limited self-care skills in diabetes management. In urban African-American populations, up to two-thirds of the episodes of DKA may be preventable by improving patient education and access to care.

Adolescent↗
PubMed1994

Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis.

OBJECTIVE: To determine the frequency of pulmonary embolism in patients admitted for treatment of deep venous thrombosis. DESIGN: An open, multicenter, dose-ranging study to assess the safety and pharmacokinetic characteristics of tissue-type plasminogen activator in deep venous thrombosis and pulmonary embolism. Perfusion and ventilation lung scans, chest roentgenograms, and venograms (in deep venous thrombosis) or pulmonary angiograms (in pulmonary embolism) were obtained before and 24 hours after inception of therapy. Heparin therapy was then administered. SETTINGS: Five tertiary-care hospitals. PATIENTS: All patients with suspected deep venous thrombosis or pulmonary embolism seen from August 1987 through November 1988 entered the study if they met inclusion criteria and if the diagnosis was confirmed by venogram (deep venous thrombosis) or pulmonary angiogram (pulmonary embolism). INTERVENTIONS: All patients received tissue-type plasminogen activator followed by intravenous heparin therapy. MAIN OUTCOME MEASURES: The primary measure was the frequency of pulmonary embolism in patients with deep venous thrombosis who had no symptoms of pulmonary embolism. This was not the original purpose of the study but emerged as an important finding as the data were analyzed. RESULTS: Nearly 40% of patients with deep venous thrombosis who had no symptoms of pulmonary embolism had evidence of pulmonary embolism based on ventilation-perfusion scan and chest roentgenogram findings. CONCLUSIONS: Because all of those considered to have embolism had so-called high-probability scan results, the frequency of embolism reported likely represents the minimum incidence of pulmonary embolism in patients with deep venous thrombosis who have no embolic symptoms. These data emphasize that venous thromboembolism is one disorder.

Angiography↗
PubMed1994

Accumulation of 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents by double-crested cormorant (Phalacrocorax auritus, Pelicaniformes) chicks in the North American Great Lakes.

Concentrations of polychlorinated biphenyls (PCBs), and 2,3,7,8-tetrachlordibenzo-p-dioxin equivalents (TCDD-EQ) were determined in eggs and chicks of double-crested cormorants (DCC) which were collected in 1989 from eight locations in the Laurentian Great Lakes. The mean biomagnification factor (BMF) from forage fish to eggs was found to be 31.3. Absolute and relative concentrations as well as rates of accumulation of total concentrations of PCBs and TCDD-EQ were measurable in all of the samples. The concentrations of both PCBs and TCDD-EQs decreased immediately upon hatching of chicks, due to growth dilution. Initial decreases in absolute masses of TCDD-EQ in chicks were also observed, which indicates that there can be significant elimination of these compounds during early development. The initial rates of accumulation by chicks were dependent only on the mass of fish consumed. After the chicks began thermoregulating, the rates of accumulation, expressed as a concentration, normalized to body weight, became greater. Rates of accumulation of both PCBs and TCDD-EQ were correlated with their respective concentrations in forage fish consumed by the chicks. The relative potency, expressed as the ratio of the concentration of TCDD-EQ to that of total PCBs was calculated to determine if there was significant trophic-level enrichment of the TCDD-EQs, relative to total concentrations of PCBs. A significant enrichment was observed at the more and less contaminated locations, but the degree of enrichment was greater at the less contaminated locations (26 vs 72 micrograms/g).

Animals↗