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Biomedical subjects

D J Steedman

Publications and source records attributed to D J Steedman.

At least 37 records · Page 2Linked to original sources
PubMed1991

Gastric emptying following Colles' fracture.

There are few complications associated with intravenous regional anaesthesia but convulsions with loss of consciousness induced by local anaesthetic toxicity may result in pulmonary aspiration. In many hospitals, patients are fasted prior to the procedure although such a delay would be of little value if gastric emptying was inhibited following painful injury. Utilizing the kinetics of paracetamol absorption, we investigated the rate of gastric emptying in patients sustaining a Colles' fracture within the previous 4 h. Post-manipulation control values were obtained at their first out-patient attendance. There was no statistically significant difference in the rate of gastric emptying. Since gastric emptying is not delayed by a recent Colles' fracture, the simple precaution of fasting patients prior to intravenous regional anaesthesia should reduce the risk of pulmonary aspiration.

Acetaminophen↗
PubMed1991

Acute gastric dilation after trauma.

A prospective study of 100 trauma patients admitted to the resuscitation room was performed. Acute gastric dilatation was confirmed radiologically in 17 patients. The mechanism of injury was blunt trauma in 91 patients and penetrating in nine. The mean Injury Severity Score was 17. Of those patients with acute gastric dilatation, 13 (76%) had no abdominal injury. Acute gastric dilatation was suspected clinically in nine of 17 patients (53%) in whom the diagnosis was confirmed radiologically. Nasogastric tubes were placed in 31 patients. Fifteen patients had a diagnostic peritoneal lavage and nine of these had nasogastric aspiration before the procedure. Of 28 patients secondarily transferred from another hospital, three (11%) had undergone nasogastric intubation before transfer, five (18%) had acute gastric dilatation on admission and four (14%) had radiological evidence of pulmonary aspiration. Complications associated with acute gastric dilatation included gastric haemorrhage in six patients (35%), pulmonary aspiration in two (12%) and prolonged ileus in one (6%). Placement of a nasogastric tube in the absence of a clear contraindication, either before inter-hospital transfer or soon after admission to the resuscitation room is strongly recommended in the management of the multiply injured patient.

Acute Disease↗
PubMed1990

Medical teams for accidents and major disasters.

Recent major disasters within the United Kingdom have highlighted the role of mobile medical teams. A prospective study of 244 call-outs demonstrated that an experienced medical team can be mobilized rapidly and effectively in response to accidents and potential disasters. An accident flying squad reduced mortality in the severely multiply-injured patient by providing treatment at the scene of the accident in 234 patients. The argument supporting the development of flying squads for accidents and major disasters can be based on the objective evidence of their value rather than on their empirical and emotional appeal.

Accidents↗
PubMed1990

Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department.

Hypoglycaemia remains a serious and much feared complication of insulin therapy. In this study, patients attending an accident and emergency department in hypoglycaemic coma were randomized to treatment with either intravenous dextrose (25g) or intramuscular glucagon (1mg), administered into the right thigh. Restoration of normal conscious level was slower after glucagon than dextrose (9.0 vs 3.0 min, P less than 0.01), although the average duration of hypoglycaemic coma was 120 min. Two patients in the glucagon-treated group, who failed to show satisfactory recovery after 15 min, required additional treatment with intravenous dextrose. On questioning following recovery, all except two patients reported loss of awareness of the onset of hypoglycaemia Intramuscular glucagon is valuable in the treatment of severe hypoglycaemia outwith hospital and, although the slightly slower and less predictable recovery may appear to make it a less attractive option than intravenous dextrose in the accident and emergency department, this must be balanced against the advantages of ease of administration and a lower incidence of serious adverse effects.

Diabetes Mellitus, Type 1↗
PubMed1990

Measurement of end-tidal carbon dioxide concentration during cardiopulmonary resuscitation.

End-tidal carbon dioxide concentrations were measured prospectively in 12 cardiac arrest patients undergoing cardiopulmonary resuscitation (CPR) in an accident and emergency department. The end-tidal carbon dioxide (CO2) concentration decreased from a mean (+/- SD) of 4.55 +/- 0.88% 1 min after chest compression and ventilation was established, to values ranging from 2.29 +/- 0.84% at 2 min to 1.56 +/- 0.66% following 8 min of CPR. Spontaneous circulation was restored in five patients. This was accompanied by a rapid rise in end-tidal CO2 which peaked at 2 min (3.7 +/- 1.08%). Changes in end-tidal CO2 values were often the first indication of return of spontaneous cardiac output. There was a significant difference in the end-tidal CO2 in patients undergoing CPR before return of spontaneous circulation (2.63 +/- 0.32%) and patients who failed to develop spontaneous output (1.64 +/- 0.89%) (p < 0.001). We conclude that measurement of end-tidal CO2 concentration provides a simple and non-invasive method of measuring blood flow during CPR and can indicate return of spontaneous circulation.

Adult↗
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

Severity of free-fall injury.

Free-falls frequently result in death in the United Kingdom. The injuries sustained by free-fall victims are often misdiagnosed. The severity of deceleration injuries sustained by 28 free-fall victims, as assessed by the Injury Severity Score, was shown to be related to the height of the fall. A high proportion of visceral injuries resulted when patients fell from a height of 6.1 m or more. It is recommended that patients injured as a result of a fall from such a height should be sent to a major accident centre. Only by appreciating the potential severity of injury sustained by free-fall victims, usually related to the height of the fall, may earlier and more accurate diagnosis be made and appropriate management instituted.

Abdominal Injuries↗
PubMed1987

CSF rhinorrhoeae: significance of the glucose oxidase strip test.

Many authoritative medical textbooks recommended use of glucose oxidase reagent strips to distinguish cerebrospinal fluid rhinorrhoea from clear nasal discharge following head injury. A study of 50 subjects with clear nasal and lacrimal secretions, demonstrated a large proportion of positive results for glucose (44 per cent). Thirteen secretions (26 per cent) contained glucose in a concentration within the normal range for CSF. The recommended use of glucose oxidase test strips for differentiating CSF leakage from other clear nasal secretions is therefore without foundation.

Cerebrospinal Fluid Rhinorrhea↗
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↗
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

Artificial ski slope injuries: a 1-year prospective study.

Skiing is one of the fastest growing sports in the United Kingdom. A prospective study of 119 patients who sustained injuries while skiing on the Edinburgh artificial ski slope was performed. The ratio of injury of the arm to that of the leg was 4.2:1, which is the reverse of that found with snow skiing. In particular, thumb injuries accounted for 32 per cent of all injuries. Attention is drawn to the high incidence of damage to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which is related to the construction of the 'snow slope' matting. The pattern of injury is described and the mechanisms of injury discussed.

Adolescent↗
PubMed1985

Intravenous drug abuse and the accident and emergency department.

A 4-month prospective study of intravenous drug abusers attending an accident and emergency department was performed. A total of 92 patients presented with 104 new complaints. Seventy-eight per cent of patients were under 30 years of age and 28% were female. The primary reason for attendance was related to trauma in 30% of attendances, accidental or deliberate overdose in 26% and as a result of infection in 26%. A total of 37% of all attendances resulted in admission and two patients died in the department. Fifty-four patients (58%) had radioimmunoassay performed for hepatitis B markers and there was evidence of past or ongoing infection in 87% of these patients. Only three patients (5.6%) were HBsAg positive at the time of presentation. Accident and emergency staff should be made aware of the pattern of attendance of intravenous drug abusers and the particular problems they present.

Accidents↗