PubMed Health⌕ Search

Biomedical subjects

I Greaves

Publications and source records attributed to I Greaves.

17 recordsLinked to original sources
PubMed2002

Fluid resuscitation in pre-hospital trauma care: a consensus view.

Fluid administration for trauma in the pre-hospital environment is a challenging and controversial area. The available evidence does not clearly support any single approach. Nevertheless, some provisional conclusions may be drawn. It was with this intention that the Faculty of Pre-Hospital Care (RCSEd) arranged to meet in August 2000 in an attempt to reach a working consensus. The following guidelines are the result of those discussions. It is intended that they will be modified as future research brings clarity to the area. When treating trauma victims in the pre-hospital arena cannulation should take place en route, where possible. Only two attempts at cannulation should be made. Transfer should not be delayed by attempts to obtain intravenous access. Entrapped patients require cannulation at the scene. Normal saline may be titrated in boluses of 250 ml against the presence or absence of a radial pulse (caveats; penetrating torso injury, head injury, infants).

Emergency Medical Services↗
PubMed2001

Write a case report.

Case reports are often seen as a relatively easy way of getting published. Despite this, much wasted time and effort on the part of authors, reviewers and editors might be saved if intending authors followed some simple guidelines before committing themselves to paper. The rejection rate for case reports is extremely high. There are two main reasons for this: inappropriate case selection and inadequate attention to detail in case preparation. This article aims to offer a template to the clinician who is considering writing a case report, in order to make the most efficient use (in terms of published results) of the time available.

Humans↗
PubMed2000

Regular attenders to the accident and emergency department.

OBJECTIVES: To examine the profile of regular attenders to an accident and emergency (A&E) department, and to estimate the percentage of the overall departmental workload attributed to this group of patients, together with the resultant cost to the department of these attendances. METHODS: A retrospective study of regular attenders to the A&E department at Hull Royal Infirmary was conducted between 1 January 1998 and 30 June 1998. The information gathered included age, sex, marital status, accommodation, investigations performed, concurrent alcohol use, presenting complaints and disposal. RESULTS: The A&E department at Hull Royal Infirmary sees approximately 87 000 new patients per year. Forty regular attenders presented 475 times in six months accounting for 1.1% of the departmental workload. The most common presenting complaints were overdose (27.4%), minor injuries (19%), alcohol intoxication (14%) and seizures (10.5%). Eighty per cent of patients were single and 7.5% were of no fixed abode. A total of 191 admissions resulted and the cost to the department for investigations performed was between ł2709.59 and ł3739.85. The cost of inhospital admissions was in excess of ł34000. CONCLUSION: Improved management of these patients together with a reduction in their alcohol intake may lead to a significant reduction in both workload for accident departments and hospitals and in the number of regular attenders.

Adolescent↗
PubMed2000

Equipment for immediate medical care.

The equipment lists provided in this article are not intended to be proscriptive or definitive. They are simply an illustration of the logical application of equipment selection and packing principles according to the likely needs of the casualty. Although trained personnel with relatively little equipment can perform simple interventions, optimal care requires some advanced techniques and good quality comprehensive equipment. Such equipment is available for pre-hospital use. Regardless of what equipment is packed, the immediate care practitioner must understand the circumstances in which the equipment is likely to be used and tailor it to the likely needs of the casualty.

Choice Behavior↗
PubMed1997

Epidemic of asthma in a wood products plant using methylene diphenyl diisocyanate.

Eighteen employees with lower respiratory symptoms later confirmed to be occupational asthma were referred for evaluation. All were employees of a single wood products plant using heated methylene diphenyl diisocyanate (MDI) in the manufacture of a synthetic wood product. Of the 18, 15 had no prior airway symptoms or other known bronchial injury, and 16 had positive methacholine bronchial provocation tests. All cases occurred during a 2.5-year period after exposure to a new manufacturing process using steam-heated MDI resin in a new manufacturing facility. Initially, employees developed symptoms related to the start-up process in the plant, with possible higher MDI exposures and probable higher resin temperatures. Later, most employees who developed new symptoms worked in areas of the plant where they were exposed mostly to heated boards. This suggests MDI sensitization arising at lower temperatures than previously considered likely for this substance.

Adult↗
PubMed1997

The Pre-Hospital Emergency Care Course (PHEC). A TA initiative.

The Pre-Hospital Emergency Care (PHEC) course is a 3 day course run by BASICS Education for the Royal College of Surgeons of Edinburgh, Royal College of Nursing and the NHS Ambulance Service. PHEC teaches and examines the care of medical, trauma, paediatric and obstetric patients in the pre-hospital environment. 243 (The Wessex) Field Hospital has held two of an intended ongoing programme of PHEC courses and they have proved suitable for medical and dental officers, nurses and combat medical technicians. We believe the courses to have a valuable role in the ongoing training of CMT is as well as medical and nursing officers. Furthermore, being nationally recognised qualifications we hope the courses will have a positive effect not only on personnel retainment but on recruitment. Demand for places has far exceeded availability and we believe will continue to do so as these courses are not only highly relevant to TA service but to civilian career progression. Furthermore, as the humanitarian role of the armed forces becomes more and more important the PHEC course will become increasingly relevant to regular army personnel not only during their service but also after leaving the forces. The ultimate beneficiaries will be our patients.

Curriculum↗
PubMed1996

Management of drug overdoses in accident and emergency departments in the United Kingdom.

A questionnaire consisting of 10 overdose scenarios was sent to 190 career accident and emergency staff in the United Kingdom, asking in each case how the respondents would treat a patient to prevent drug absorption. The responses showed lack of consensus in treatment methods. There was extensive use of both ipecacuanha induced emesis and gastric lavage despite a lack of experimental evidence to support these techniques.

Adolescent↗
PubMed1993

The penetration of rufloxacin into sites of potential infection in the respiratory tract.

The concentrations of rufloxacin in the bronchial mucosal, pulmonary epithelial lining fluid and alveolar macrophages were determined in specimens obtained at fibreoptic bronchoscopy. A single oral dose of rufloxacin 400 mg was administered and the samples obtained in the following 72 h. The mean peak serum concentration was 3.56 mg/L, yet the agent was concentrated 1.8-fold in bronchial mucosa, 21.6-fold in alveolar macrophages and 7.7-fold in epithelial lining fluid (as measured by AUC ratios).

Anti-Infective Agents↗
PubMed1993

Relapses in patients with a systemic vasculitis.

Treatment with cyclophosphamide and steroids has greatly improved survival in patients with systemic necrotizing vasculitis but does not always provide a complete cure. There are as yet few data on the incidence, pattern and outcome of relapses in these diseases. We studied relapses in 150 consecutive patients with an idiopathic necrotizing vasculitis: 12 with classical polyarteritis (CPAN); 95 with microscopic polyarteritis (MPA); 28 with Wegener's granulomatosis (WG); and 15 with limited Wegener's granulomatosis (LWG). The relapse rates and median time to relapse in months were: CPAN, 41.7%/33; MPA, 25.4%/24; WG, 44%/42; LWG, 52%/18. The clinical features of relapse were similar to or more aggressive than those of the original presentation in CPAN and LWG and included renal disease for the first time, but in MPA and WG, relapse involved less renal involvement in the majority of cases. Laboratory tests, although often positive at relapse, were unhelpful in its prediction. The considerable accumulative non-fatal relapse rate contrasts with the very good long-term survival rates, and confirms the importance of long-term follow-up in systemic vasculitis.

Adult↗
PubMed1992

Pigeons and peritonitis?

We report an outbreak of fungal peritonitis due to Candida parapsilosis in 12 patients undergoing chronic ambulatory peritoneal dialysis (CAPD). All 12 patients were treated by removal of the CAPD catheter together with systemic antifungal therapy. There were no peritonitis-related deaths. Four patients were successfully returned to CAPD at a later date. Microbiological investigation during the outbreak demonstrated colonization of various areas of the CAPD Unit and medical ward with the organism. C. parapsilosis was also isolated from pigeon guano obtained from window-sills. The number of cases of peritonitis due to this organism decreased markedly after bird-proof netting was installed. We believe that this is the first report of an outbreak of CAPD peritonitis due to faecal carriage of C. parapsilosis by pigeons.

Adult↗
PubMed1992

Increased prevalence of renal biopsy findings other than diabetic glomerulopathy in type II diabetes mellitus.

It is a widely held view that when a patient with type I diabetes mellitus and diabetic retinopathy or neuropathy develops renal impairment the renal lesion will be diabetic glomerulonephropathy. This has been extrapolated to apply to type II diabetes. We have performed a retrospective study of the clinical data of patients with diabetes mellitus who have had a renal biopsy between November 1980 and December 1990. Seventy-one patients were biopsied, data were available on 68. Nineteen of 22 type I diabetics had diabetic glomerulopathy, two had diabetic glomerulopathy in addition to another lesion only one patient did not have diabetic glomerulopathy. Twenty-three of 46 type II diabetics had diabetic glomerulopathy alone 22 having an alternative diagnosis. Eight further patients were identified who were not known to be diabetic at the time of renal biopsy, but whose biopsies revealed diabetic glomerulopathy. These data suggest that patients with type II diabetes and renal impairment should have a renal biopsy as part of their investigation.

Adult↗
PubMed1980

Severe lung oedema and fatal consumption coagulopathy after funnel-web bite.

A young woman who was bitten by a male funnel-web spider presented with early, severe pulmonary oedema which was successfully managed with positive and expiratory pressure ventilation. However, three days after envenomation, she developed a consumption coagulopathy which proved fatal. It is evident that our knowledge of the actions of the toxin is incomplete, and that the standard method of management advocated by previous writers is inadequate.

Adult↗