Biomedical subjects
Publications and source records attributed to C V Egleston.
A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force.
This study's objective was to examine the nature, cause and frequency of injury resulting from equestrian sport in paediatric patients attending two accident and emergency departments. We recorded the attendances of patients aged less than 16 years with equestrian-related trauma in 1 year. Demographic details, injury, mechanism of injury, rider experience and use of protective equipment were noted. There were 41 attendances (39 female, two male, median age 12 years). Thirty-one were injured while mounted, 10 while dismounted. The commonest group of injuries were soft tissue injuries of the lower limb (13 cases), soft tissue injuries of the upper limb (12 cases), fractures of the upper limb (nine cases), and minor head injury (seven cases). There was one case of severe head injury. Two patients required admission to hospital. The commonest mechanism of injury in the mounted group was a fall or throw (23 cases), in the dismounted group injuries were most commonly the result of being trodden on or being kicked (seven cases). The majority of equestrian-related trauma was minor in this study. The possibility of severe trauma exists. Emergency physicians working in areas where equestrian sport is popular should be aware of the likely injuries and their treatment.
BACKGROUND: Established practice is for the relatives of critically ill patients to be excluded from the clinical area during resuscitation. We aimed to discover whether relatives wanted to be present during the resuscitation of a family member and whether witnessing resuscitation had any adverse psychological effects on bereaved relatives. METHODS: In this pilot study, relatives of patients who required resuscitation were given the option to remain with the patient during resuscitation or were not given this choice and directed to the relatives' room (control group). The unit of randomisation was the patient who required resuscitation and not the relatives. One close relative was paired with each patient. All relatives were accompanied by a chaperone who gave emotional support and provided technical information on the resuscitation. Relatives were followed up 1 month after the resuscitation. We used a questionnaire to ask about the decision to be present or absent during resuscitation. Bereaved relatives also completed five standardised psychological questionnaires to assess anxiety, depression, grief, intrusive imagery, and avoidance behaviour. FINDINGS: 25 patients underwent resuscitation (13 in witnessed resuscitation group, 12 in control group). Three patients in the witnessed group survived, all the control-group patients died. Two relatives in each group were lost to follow-up. Thus, eight relatives who witnessed resuscitation and ten control-group relatives were followed up. There were no reported adverse psychological effects among the relatives who witnessed resuscitation, all of whom were satisfied with their decision to remain with the patient. The clinical team became convinced of the benefits to relatives of allowing them to witness resuscitation if they wished, so the trial was terminated. INTERPRETATION: In the context of the emergency department, routine exclusion of relatives from the resuscitation room may no longer be appropriate.
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The use of airguns in attempted suicide is uncommon. In such instances, the surface wounds caused by discharged pellets may be inconspicuous or appear deceptively trivial to the medical examiner. Airgun pellets however are easily capable of penetrating the skull or abdominal cavity when fired at the close ranges involved in suicide attempts. The destructive power of these weapons at close range should not be underestimated. We describe three cases of attempted suicide and review the other nine cases reported in the medical literature: of the 12 suicide attempts there were three fatalities. Seventeen out of a total of 19 pellets fired penetrated either the cranial or peritoneal cavity or damaged deep structures. Most of the victims were male. The majority of wounds were right sided. Four of the attempts were extremely determined, involving repeated discharge of the airgun or the use of other means to effect suicide.
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Two cases of traumatic asphyxia in young children are reported. The first was a 2 year old child run over at low speed by the front wheels of a delivery van. He made an uncomplicated recovery. The second child was pinned to the floor by an empty chest of drawers in an unwitnessed accident. He was discovered in cardiac arrest and resuscitation was unsuccessful. The outcome following traumatic asphyxia is a product of duration of compression and the weight involved. Considerable weight can be tolerated for a short period, whereas a comparatively modest weight applied for a longer period may result in death.
The case is reported of a toddler who presented with an apparent febrile convulsion. The final diagnosis was that of accidental ingestion of Ecstasy. The child made an uneventful recovery. Ecstasy toxicity should be added to the list of differential diagnoses in a child presenting with fever and an unexplained seizure.
OBJECTIVE: To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients. METHODS: Patients with potential respiratory compromise admitted to the resuscitation room were assessed for widespread expiratory wheeze. This was taken as clinical evidence of airways obstruction. Expiratory capnograms of these patients and patients who had no wheeze were obtained. The traces were analysed for basic morphology and where appropriate the slope ratio (SR) between phase 1 (S1) and phase 2 (S2) of the trace was obtained. RESULTS: Thirty eight patients with a variety of clinical conditions causing potential or actual respiratory impairment were studied. All patients tolerated the nasal capnogram cannulae. Twelve had no clinical evidence of airway obstruction and all had capnograms with normal morphology. Eleven of these were analysed further. The mean value for SR was 7.57 (SEM 0.18), 95% confidence interval 6.37 to 8.77. Twenty six patients had clinical evidence of airway obstruction "sharks fin" morphology. Fourteen of these were analysed to determine SR. The mean value was 31.9 (4.46), 95% CI 22.9 to 40.8. There was a significant difference in the mean value for SR between the two groups (P << 0.001). CONCLUSIONS: Capnography may be used as a means of continuous respiratory monitoring in non-intubated acutely ill patients. Capnogram analysis may be used to indicate airway obstruction in these patients. Further work is required to correlate curve indices to degree of airway obstruction.
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Gastrointestinal complications after cardiac surgery are uncommon, but are associated with a high morbidity and mortality. Over 11 years 8559 procedures requiring cardiopulmonary bypass were performed in this unit and 35 patients were identified who developed gastrointestinal complications after surgery, an incidence of 0.41%. There were nine deaths in this group, a mortality of 25.7% compared with an overall mortality after cardiac surgery in Ireland ranging from 3.24% to 4.81%. These complications required surgery in 21 patients. The most common indication for surgical intervention was upper gastrointestinal bleeding in 10 patients, three patients had acute pancreatitis, two patients had perforated peptic ulcer; two patients had intestinal ischaemia, with five cases of colon pathology. The difficulties of making an early diagnosis are outlined and a low threshold to exploratory laparotomy is recommended.