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Biomedical subjects

D W Hamer

Publications and source records attributed to D W Hamer.

12 recordsLinked to original sources
PubMed2000

Toxicological screening in trauma.

OBJECTIVES: To determine the prevalence and patterns of alcohol and drug use in patients with major trauma. METHODS: Consecutive trauma patient enrollment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results. RESULTS: There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone. CONCLUSIONS: There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population. A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs, and trauma, together with ethically acceptable methods of screening, are discussed.

Accidental Falls↗
PubMed1998

Flow diagram or prose: does the format of practice guidelines matter?

The aim of this study was to compare the performance of two formats (prose and flow diagram) of the guidelines for management of paracetamol poisoning, and to assess the likely performance without access to the guidelines. A prospective questionnaire study of the management of seven hypothetical cases of paracetamol ingestion was carried out by accident and emergency senior house officers at a regional induction course. No differences were found between the two formats. The proportion of correct answers was 37% in the flow diagram and 31% in the prose group (95% confidence interval for the difference -8% to 20%). In the group with neither format of the guideline the proportion of correct answers was lower: 19% (95% confidence interval for the difference between this group and the group with flow charts 6.9% to 30.6%, for the difference between this group and the group with the prose format 0.4% to 24.8%). The time taken to answer the questions did not vary between the groups. These data do not support the exclusive use of either format. They suggest that management of paracetamol poisoning is less likely to be correct if staff do not have access to the guidelines.

Acetaminophen↗
PubMed1996

Reviews in accident and emergency medicine: the past and the future.

OBJECTIVE: To determine whether reviews published in the past 10 years are as helpful as they could be to their readers, and to explain why future reviews should meet certain methodological criteria. METHODS: The quality of 16 reviews published in two journals dealing with accident and emergency medicine over 10 years was objectively assessed using 11 currently recommended criteria. RESULTS: The median number of methodological criteria satisfied was two. Only five of the reviews posed a specific question or problem and then answered this with conclusions based on evidence presented. CONCLUSIONS: If reviews are to enhance patient care, the way in which they are performed, written and used must change.

Accidents↗
PubMed1996

Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

Acute Disease↗
PubMed1994

Plasma endothelin following cardiac arrest: differences between survivors and non-survivors.

Cardiac arrest is associated with major metabolic disturbances, including severe hypoxia and large increases in circulating catecholamines, both of which are known to stimulate generation of the potent endothelium-derived vasoconstrictor peptide endothelin-1. We have, therefore, examined plasma immunoreactive endothelin concentrations following cardiac arrest. Blood was sampled at 10-min intervals from a central venous catheter inserted at onset of resuscitation in 38 patients (13 female; mean age, 67 years) presenting with cardiac arrest to the Accident and Emergency Department at the Royal Infirmary of Edinburgh. Plasma immunoreactive endothelin concentrations (mean +/- S.D.) in patients following cardiac arrest (5.4 +/- 2.3 pg/ml) were no different from those in healthy subjects (5.1 +/- 1.2 pg/ml). There was no significant difference between endothelin concentrations at presentation in survivors and non-survivors of cardiac arrest. However, non-survivors had a significant fall in endothelin concentrations with time from onset of resuscitation from 5.4 +/- 2.2 pg/ml to 3.5 +/- 1.8 pg/ml (P = 0.002), while survivors had a non-significant increase in concentrations. On multiple regression analysis there was a significant association between higher plasma endothelin concentration and survival (r = 0.37; P = 0.009). The failure of plasma endothelin to increase after cardiac arrest is unexpected. Although the fall in plasma endothelin with time in non-survivors may reflect the adverse physiological milieu that occurs during cardiac arrest, it is also possible that low endothelin concentrations contribute to the poor prognosis in this condition.

Aged↗
PubMed1993

Survival from cardiac arrest in an accident and emergency department: the impact of out of hospital advisory defibrillation.

A prospective 1-year audit of cardiac arrests treated in the Accident and Emergency department of the Royal Infirmary, Edinburgh is presented. During the period January 1st, 1991 to December 31st, 1991, 325 patients with cardiac arrest were treated. Two-hundred ninety-seven of these were 'out-of-hospital' and 28 were 'in-department' arrests. Of patients with 'out-of-hospital' ventricular fibrillation/pulseless ventricular tachycardia 22.8% were discharged. Survival rates for patients with asystole or electromechanical dissociation were very poor. The impact of semiautomatic out-of-hospital defibrillation upon the survival and number of patients presenting to the department is discussed.

Aged↗
PubMed1992

Dorsal fracture subluxation of the proximal interphalangeal joints treated by extension block splintage.

In a prospective study, 27 consecutive patients with dorsal fracture subluxation of the PIP joint were treated conservatively using an extension block splint, with good results in 70%. The percentage surface involved with the fracture varied considerably (19-77%) the average being 55%. Three patients initially managed with splintage proceeded to surgery because the splint failed to hold the joint in reduction. These patients had a less favourable outcome. We feel that all such fractures can be treated by splintage, provided that early reduction is maintained in the splint and checked by serial radiology.

Adult↗
PubMed1992

Dorsal fracture subluxation of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb treated by extension block splintage.

In a prospective study six patients with dorsal fracture subluxation of the IP joint of the thumb or the DIP joint of the finger were treated conservatively using an extension block splint. The fracture size varied from 22% to 47% of the articular surface of the volar base of the terminal phalanx. Good or excellent results were reported in all cases except for one, which was fair. Only one case in the study complained of any pain, and this was minimal. Conservative treatment using extension block splintage for this injury is as good as a surgical approach.

Adult↗
PubMed1987

Femoral nerve block in the initial management of femoral shaft fractures.

The aim of this study was to demonstrate that the under-used technique of femoral nerve block (F.N.B.) (Berry, 1977) has excellent analgesic action for femoral shaft fractures when performed by junior staff. It had no recorded side effects and was used in all age groups for fractures at all levels along the femoral shaft. Twenty-seven consecutive patients were studied as they presented in an accident room, all received a femoral nerve block (10 ml 1% Lignocaine with 1:200,000 adrenaline) from unsupervised junior accident and emergency staff instructed in the technique. Each case was subsequently followed up, and both the delay before the onset of analgesia and total duration of analgesia, together with its efficacy, were assessed. A further F.N.B. using a different agent (10 ml 0.5% bupivacaine) was performed and the same parameters were assessed. Both agents gave effective analgesia of varying duration at all levels of fracture site.

Analgesia↗
PubMed1981

Anatomy and blood supply of the coeliac-superior mesenteric ganglion complex of the rat.

The anatomy of the coeliac-superior mesenteric ganglion (CSMG) complex of 28 female Wistar rats was studied by serial paraffin sections and found to be consistent in composition and in relations. The CSMG comprises tow suprarenal ganglia in continuity with the major splanchnic nerves, these continuing as splanchnic trunks into paired coeliac ganglia. The left coeliac ganglion is larger than the right as it has a superior mesenteric component related to the artery of that name. Lastly, intermesenteric ganglia are related to the renal and ovarian arteries and to the origin of the intermesenteric nerves. Ink injections and microvascular casts indicate that the main extrinsic blood supply to the CSMG is derived from the inferior phrenic artery, a branch of which enters the complex at the suprarenal ganglia and supplies the CSMG via the splanchnic trunks. Also, recurrent branches of the ovarian arteries enter the intermesenteric nerves to supply the complex at its caudal pole. A few small arteries not associated with nerves and probably derived from lumbar arteries also supply the CSMG complex. The two major post-ganglionic nerve trunks have an abundant vasculature in continuity with that of the CSMG but whose origin and direction of blood flow has yet to be determined.

Animals↗