A nation divided.
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Emergency Service, Hospital↗
Biomedical subjects
W G Morrison
Publications and source records attributed to W G Morrison.
Role of thrombolytic agents in cardiac arrest.
The prognosis of patients having a cardiac arrest is generally poor, with a few exceptions. Interventions that aim to improve outcome in cardiac arrest have proved to be disappointing. In particular, no drug has been reliably proved to increase survival to discharge after cardiac arrest. Given that coronary thrombosis in situ and pulmonary thromboembolism are implicated in a large proportion of patients with cardiac arrest, the use of thrombolytic agents has been suggested. Case reports and animal studies have shown favourable results, and have proposed plausible mechanisms to explain them. This is a review of the current literature focusing on the use of thrombolysis during cardiac arrest. A comprehensive literature search was carried out on Medline from 1966 to January 2006, Embase from 1988 to January 2006 and the Cochrane Library, using the Ovid interface. Six articles were selected for review. Although some results are encouraging, all the studies currently available are limited by size and flaws in design.
Animals↗
Interpretation of the emergency electrocardiogram by junior hospital doctors.
OBJECTIVE: To assess the ability of a cohort of junior hospital doctors to interpret ECGs which have immediate clinical relevance and influence subsequent management of patients. METHODS: 57 junior hospital doctors were interviewed and asked to complete a standard questionnaire which included eight ECGs for interpretation and a supplementary question relating to the administration of thrombolytic treatment. Each doctor was assessed over a 48 h period while they performed their daily clinical duties. RESULTS: The major abnormality of anterior myocardial infarction was recognised by almost all doctors. There was difficulty in the interpretation of posterior myocardial infarction and second degree heart block. Most myocardial infarctions would have been given satisfactory thrombolysis, but there was a reluctance to use this treatment in patients with posterior myocardial infarction and left bundle brach block. A few patients without myocardial infarction would have received thrombolytic treatment. CONCLUSIONS: There is varying ability among junior hospital doctors in the interpretation of the emergency electrocardiogram. The results are of concern as poor interpretation of the ECG can result in inappropriate management. As a result of the findings of this study it is proposed to introduce more formal training in the interpretation of clinically relevant ECG abnormalities for junior hospital doctors.
Clinical Competence↗
Transthecal digital block.
Transthecal digital nerve block is performed by a palmar percutaneous injection of local anaesthetic into the flexor tendon sheath. Total analgesia of the digit is achieved rapidly. This technique was carried out on 46 patients in the accident and emergency department. Successful anaesthesia was obtained in 45 patients. There were no complications.
Adolescent↗
Pseudoaneurysm and penetrating trauma.
Three patients who developed pseudoaneurysms following penetrating vascular injuries are presented. Attention is drawn to the variable period of time between the initial injury and presentation. The necessity of maintaining an awareness of this problem is emphasized.
Adult↗
Accidental golf club injuries.
Over a 2 month period, 33 patients with injuries caused by golf clubs were identified among attenders at the accident and emergency department at Glasgow Royal Infirmary. The vast majority of these were to the face and head, including three compound skull fractures. Attention is drawn to the average age of those injured (8.1 years) and to the fact that only one of the injuries occurred on a golf course. The dangers of unsupervised experimentation with golf clubs by young children are emphasized.
Accidents↗
Use of the emergency ambulance service to an inner city accident and emergency department--a comparison of general practitioner and '999' calls.
Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a '999' call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.
Adolescent↗
A study of the content of general practitioners' referral letters to an accident and emergency department.
A two-week prospective study was undertaken to assess the quality and content of referral letters from the primary care services to an inner city accident and emergency department. It was found that the majority of letters fell short of commonly accepted minimum standards. A comparison was also made between letters from general practice principals and deputising service doctors. Recommendations for improvement in written communication are discussed.
Correspondence as Topic↗
Electrocardiograph interpretation by junior doctors.
The object of this study was to assess the ability of junior doctors in the accident and emergency department to detect electrocardiographic (ECG) abnormalities. The ECG's performed in this department were monitored over a 4 week period. The initial diagnosis by the accident and emergency doctor was compared with the report from the cardiologist on 126 ECG's which showed abnormalities. The error rate was 19.8%. Of those abnormalities which were graded as clinically significant only 2 (4.4%) were missed. The danger of missing acute changes is emphasized and proposals discussed which may reduce their frequency.
Clinical Competence↗
The general practitioner's use and expectations of an accident and emergency department.
In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.
Attitude of Health Personnel↗
Focus on litigation support. Part 2: How to use an expert witness.
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Expert Testimony↗