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Biomedical subjects

C E Robertson

Publications and source records attributed to C E Robertson.

At least 55 records · Page 3Linked to original sources
PubMed1990

An objective analysis of an accident flying squad.

An objective evaluation of an accident flying squad, in relation to trauma call-outs during a six month period, was performed using the Injury Severity Score and the recently described Revised TRISS methodology. We have demonstrated improvement in patient survival for those trauma cases treated at the scene. This has not been previously documented. Objective evaluation of these squads in relation to medical emergencies is even more difficult. The profile of these call-outs is described. (11.1%) of those treated at the scene for cardiac arrest survived to leave hospital. Ventricular fibrillation was the primary arrhythmia recorded in this group of survivors. This supports the vogue for extended ambulance personnel training.

Emergency Medical Services↗
PubMed1989

An audit of trauma deaths occurring in the accident and emergency department.

A retrospective study of all patients who died following trauma in the Accident and Emergency Department of the royal Infirmary of Edinburgh over a 4-year period revealed 50 patients (0.0002% of total attendances). Injury severity scores (ISS) and probabilities of survival (Ps) were calculated for all patients. Two-thirds had a Ps of zero while 7 (14%) had a Ps of 0.5 or more. From the information in the case records and at autopsy four deaths (8%) were considered to have been potentially avoidable on the basis of inadequate or inappropriate management. There were a further eight cases (16%) whose management appeared to have been unsatisfactory but who would have been expected to die even if given optimal treatment. These cases are discussed in detail. Difficulty in diagnosing thoracic injuries and delay in giving appropriate treatment were by far the commonest errors encountered. A protocol for the treatment of patients in cardiorespiratory arrest with thoracic injuries is presented. The importance of regular audit of trauma cases and deaths is emphasized.

Accidents, Traffic↗
PubMed1989

The basic and advanced cardiopulmonary resuscitation skills of trained hospital nursing staff.

The cardiopulmonary resuscitation skills of 105 trained hospital nurses were tested. Both basic and, for the first time in the UK, advanced skills were examined; basic skills were assessed by practical evaluation with a standard manikin and advanced knowledge by multiple choice questionnaire. No nurse adequately performed all four practical skills tested. Knowledge of the ventilatory aspects of resuscitation, defibrillation and advanced technique and drug management were also found to be poor. The findings add further support to adequate training of nurses in resuscitation skills. We describe a solution to overcome the heavy demands of such teaching and suggest that the same model be applied to the training of medical staff in resuscitation skills.

Clinical Competence↗
PubMed1989

The impact of alcohol on the acute hospital service: patient presentation, admission and the perception of alcohol use in such groups.

Patients presenting to an Emergency Department were assessed by a standard questionnaire and clinical examination as to the contribution that alcohol made to their presentation and the perception of their alcohol use. Patients under the influence of alcohol are more than twice as likely not to fill in simple questionnaires and not to perceive their alcohol consumption as different from non-drinking fellows. Emergency Departments are not the optimal site for the education and motivation of drinking patients to alter their future habits.

Alcohol Drinking↗
PubMed1987

Early emergency care study: the potential and benefits of advanced prehospital care.

Of 26358 patients taken by ambulance to the accident and emergency departments of two large hospitals, 1185 were admitted to resuscitation areas. The scope for ambulance staff to employ a range of advanced techniques at the scene of incidents was assessed by using information relating to the condition of patients when they were picked up by the ambulance and on admission, time in transit, details from hospital records, and outcome at three months. For non-survivors further assessment was made of the benefit, in terms of survival, which might have accrued had advanced techniques been used. The results of the assessment of benefit were compared with estimates of benefit from other studies. In cases of cardiopulmonary arrest the potential to save lives was less optimistic than earlier estimates, and in cases of trauma the potential to save lives was negligible.

Algorithms↗
PubMed1987

Emergency endotracheal drug administration using aerosol.

Drug administration via the endotracheal route has previously involved direct installation in bolus form. However this necessitates an interruption in ventilation and, for the administration of therapeutic agents to the lungs, may result in failure of delivery to the appropriate sites. Aerosols have advantages over other routes of administration since the drug is delivered directly to its required site of action. Treatment with nebulised beta-2 agonists is the initial treatment of choice in acute severe asthma and a small number of such patients require immediate intubation and ventilation. We describe a technique for aerosol delivery using a nebuliser which can be used in intubated patients during manual intermittent positive pressure ventilation using a bag-valve resuscitator.

Adult↗
PubMed1987

Carbonated drinks, thiamine deficiency and right ventricular failure.

A 69 year old male presented with clinical features of right ventricular failure. A dilated poorly contracting right ventricle was confirmed by echocardiography and radionuclide ventriculography, with subsequent improvement following thiamine replacement. Wet beriberi is a result of thiamine deficiency and is uncommon in Europe and North America except in association with chronic alcohol abuse. We report a patient with beriberi presenting unusually with severe right-sided cardiac failure, with documented impairment of right ventricular function, which improved with thiamine replacement. His dietary intake of thiamine was low because of excess intake of carbonated drinks and carbohydrates.

Aged↗
PubMed1986

A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder.

Two methods of reduction for anterior dislocation of the shoulder were compared in 111 patients. Milch's technique was found to be atraumatic and relatively painless. Greater success with Milch's technique was experienced in patients under 40 years of age in whom the dislocation had been present for less than 4 hours. Milch's technique should be tried initially in patients fulfilling these criteria. In other cases Kocher's technique should be used first, especially in those of heavy build.

Age Factors↗
PubMed1986

The urgency distribution of an accident and emergency department's workload.

The perceived urgency of 2000 consecutive patients attending the Accident and Emergency Department of the Royal Infirmary, Edinburgh, was assessed using a Linear Analogue Scale. Each patient was assessed by the receptionist, the receiving nurse and the treating doctor. The distribution of urgency rating produced for this patient group was shown to be comparable for each status of assessor, and to correlate with other outcome criteria such as admission and referral rates. The linear scale was also shown to correlate with retrospective assessment using a time-guided category scale. The accident and emergency department workload is predominantly of low urgency (90% less than 5 on a 0-10 scale). Older patients tend to have higher urgency ratings than younger patients and those referred by ambulance, either via general practitioner or 999 calls, have similarly higher urgency distributions. This study provides a basis for the development of a guided category scale for functional triage of accident and emergency departments. Other scoring systems have attempted to similarly quantify the medical component of the workload (Coira & Rothstein, 1983; Peel et al., 1962). However, the complexity of many of these scales, together with the difficulty in usage of so many different scales, begs a reappraisal of the overall triage of patients attending the emergency department. The aim of this study was to look at the perceived urgency distribution of patients presenting to the emergency department. We wished to compare the relative assessment of urgency by various levels of treating staff and to compare those assessments with the referral and outcome of these patients to provide the basis for the development of a comparative Triage Scale.

Accidents↗
PubMed1985

Use of ether in life-threatening acute severe asthma.

Two patients with acute severe asthma who had failed to improve with conventional treatment, mechanical ventilation, and halothane showed prompt bronchodilator response following administration of diethyl ether by inhalation. Airway pressures fell, and there was a dramatic improvement in blood gas analysis and clinical condition.

Acute Disease↗
PubMed1984

The plasma kallikrein kinin system in severely ill and traumatised patients.

Serial estimations of plasma prekallikrein in four critically ill patients in intensive care showed reduced values in each case, suggesting activation of the plasma kallikrein kinin system. In contrast, samples taken early from 15 patients attending an accident and emergency department with multiple trauma showed significantly elevated plasma prekallikrein concentrations; the significance of this observation is at present unclear.

Adult↗
PubMed1984

Elderly patients discharged from an accident and emergency department--their dependency and support.

One hundred elderly patients who had attended an accident and emergency department and had been discharged were visited at home shortly afterwards. Compared to their previous level of function, 52 showed a minor or major increase in dependency, usually related to trauma. Scrutiny of accident and emergency records showed only scanty documentation of dependency, function and support arrangements. Available statutory services for dependent elderly in the community were under-utilized by these patients. In 39 of the 52 cases with increased dependency relatives had provided additional support.

Aftercare↗