Biomedical subjects
Publications and source records attributed to S V Rudland.
The general practitioner's (GP's) doctor's bag is exposed to extreme temperatures that may affect the stability of the drugs it contains. Adrenaline (1:1000 solution) is more stable than previous studies would suggest. GPs carry out-of-date drugs despite stating that they regularly check expiry dates.
OBJECTIVE: To define usual colour and site of storage of visiting bags in general practitioners' cars and to investigate effect of these variables on temperature inside bag. DESIGN: Questionnaire to general practitioners; serial temperature measurements from paired black visiting bags at different storage sites and from bags of different colour. SETTING: South Devon coastal town during May and June. SUBJECTS: 200 general practitioners, of whom 145 returned legible questionnaires. MAIN OUTCOME MEASURES: Bag colour, duration and site of storage, temperature inside black bags at defined storage sites, and effects of bag colour on internal temperature. RESULTS: 111 (77%) of the general practitioners carried a black visiting bag, and 76 kept their bag in their car all day. The bag was coolest in the car boot, but irrespective of storage site, maximum internal temperature of the bag was always over 25 degrees C and reached up to 80 degrees C. Spraying a black bag silver significantly reduced the bag's internal temperature (mean difference 8.37 degrees C (95% confidence interval 6.68 to 9.86 degrees C) df = 59, t = 10.29, P < 0.001). CONCLUSIONS: General practitioners should use a silver coloured visiting bag; when visiting, they should store it in their car boot; at other times they should remove it to a cooler site.
A Royal Naval field surgical team deployed to Iraq for 6 weeks. Seventy-one anesthetics were administered to 52 patients. The Triservice anesthetic apparatus (TSA) was used with controlled ventilation and either halothane plus trichloroethylene or isoflurane. Other techniques included spontaneous ventilation via the TSA, ketamine and midazolam, either with or without controlled ventilation, or local anesthesia. A simple modification allowed preoxygenation with 100% oxygen. Controlled ventilation with air alone was usually associated with satisfactory pulse oximetry and oxygen economy. Isoflurane was not significantly hypotensive and recovery was more rapid than with halothane/trichloroethylene. Drawover techniques with controlled ventilation were satisfactory for children as small as 6.5 kg. Overnight ventilation was instituted on three occasions, and it was found that a simple positive end expiratory pressure system could be applied to the Laerdal valve. Pulse oximetry, ECG, and automatic arterial pressure monitoring facilities were used. The total drug expenditure for all 71 anesthetics was only $178.
Nine Kurdish children were admitted to a British Surgical Support Team facility in Northern Iraq, requiring resuscitation for dehydration estimated to be of 10% loss of body weight. Systemic access was by intravenous (IV, 6 patients), intraosseous (IO, 6 patients) and/or intraperitoneal cannulation (IP, 4 patients) and resuscitation was according to a defined protocol. Insertion times, maximum initial flow rates and complications were assessed. The mean insertion times were 78, 112 and 26 seconds and the mean maximum initial flow rates of crystalloid were 240, 60 and 400 mls/hour for IV, IO and IP routes respectively. One IV lasted more than 24 hours and three tissued. One IO cannula blocked, and one IP was removed because of saline extravasation. IO bolus injections were painful. Total volumes infused and time to adequate hydration varied widely and there were no correlations. The mortality was 33%, compared with 11% for 18 less severely dehydrated children. It is concluded that the IP and IO routes allow severely dehydrated children to be resuscitated without significant complications when IV access is difficult to establish.
The principles of Advanced Trauma Life Support (ATLS) were adopted by a Royal Navy surgical team deployed to northern Iraq. Over a 6-week period, 18 casualties of both military and civil trauma required active resuscitation, 10 being under the age of 16 years. Triage of multiple casualties was necessary on three occasions. Two patients died. It was difficult to exclude cervical spine injury. Venous cut-down was frequently unsuccessful, so that internal jugular vein cannulation was life-saving. Crystalloid was used as the primary infusion without apparent disadvantage. Cross-matched blood was unavailable and one patient died with haemolysis after massive transfusion. Hypothermia was a problem despite the high environmental temperature. Laboratory and radiological facilities were extremely limited. Non-medical staff were trained most effectively to assess vital signs, although sophisticated monitors became available. These problems are discussed and compared with previous experience. Recommendations are made to improve future outcome.
The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P < 0.05). ICV patients recovered more quickly than with HTCV (P < 0.05), but were significantly older and heavier (P < 0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only 127 pounds. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.
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Patients with Leptospirosis, usually a water borne zoonotic disease, are likely to present themselves to Royal Naval primary health carers, who deal with a young active population, frequently participating in watersports. Leptospira, which belong to the order Spirochaetaceae, comprise of two distinct species. Within each species there are a number of serologically different serovars (serotypes), arranged in related serogroups. L. interrogans var Icterhaemorrhagiae and L. interrogans var Hebdomadis serovar hardjo are the most commonly reported organisms in Great Britain. Traditionally water and sewage workers have been amongst those most frequently infected, but with improved health care awareness this group has been overtaken by farmworkers, and a growing group of people engaged in aquatic sports. Symptoms of Leptospiral infection vary in severity from a mild flu-like illness to symptoms resulting from severe renal, hepatic or meningeal involvement. Mild symptoms respond to oral penicillin, erythromycin or tetracyclines, whilst more serious illness requires i.v. penicillin and supportive nursing. Spirochaetes can be detected in culture using darkground microscopy, and sero-conversion detected by IgM specific dot ELISA techniques. Suspected sera should be sent to PHLS Leptospira Reference Unit, County Hospital, Hereford. HR1 2ER. (Tel: 0432 277117).