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Biomedical subjects

T B Hassan

Publications and source records attributed to T B Hassan.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians.

OBJECTIVES: To evaluate the introduction of a focussed assessment with sonography in trauma (FAST) scan into the early assessment of trauma patients in the UK. METHODS: The setting was an inner city teaching hospital emergency department (annual attendance 100,000). All patients aged 16 or over admitted to the resuscitation room after blunt trauma were included in a prospective observational study. Patients had a FAST scan performed at the end of the primary survey. Results were compared to results of other investigations, laparotomy, postmortem examination, or observation. RESULTS: 153 patients were entered into the study. The sensitivity of the FAST scan was 78% and specificity was 99%. CONCLUSION: FAST is a highly specific "rule in" technique and is useful in the initial assessment of trauma patients. Emergency physicians can perform FAST after a brief training period.

Abdomen↗
PubMed2005

What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study.

BACKGROUND: The Ambulance Services have a critical role in the management of acute myocardial infarction (AMI). Paramedic delivered prehospital thrombolysis (PHT) has been proposed. To the authors' knowledge there has been no research carried out to ascertain the views of paramedics. METHODS: The authors conducted a postal questionnaire study of 250 paramedics in the West Yorkshire Metropolitan Ambulance Service (WYMAS). This included the knowledge of risks and benefits of AMI treatments, and their views on possible paramedic delivered PHT. RESULTS: 193 paramedics replied (77%); of these 83% felt paramedics could deliver PHT, 67% felt thrombolysis was safe, and only 12% felt that paramedics should not carry out PHT. There was a similar preference towards autonomous PHT (42%) and telemetry with physician directed PHT (46%). 96% wanted a nationally recognised certificate. There were concerns regarding the risks of AMI treatment, with underestimates of the benefits of aspirin, and overestimates of the benefits of thrombolysis. They also greatly overestimated the risks of thrombolysis in terms of extra deaths (71%), and bleeding (90%). CONCLUSION: The majority of paramedics in WYMAS responding to the questionnaire supported the principle of PHT. Concerns included the risks of thrombolytic treatment, training, and the medico-legal implications for them as individual paramedics. Models for paramedic thrombolysis for each ambulance service should include the views of paramedics.

Ambulances↗
PubMed2003

The point of the needle. Occult pneumothorax: a review.

The case of a patient with an unusual medical condition and an occult pneumothorax is presented. The evidence for management of occult pneumothorax particularly in patients with underlying lung disease is reviewed and solutions to the acute clinical problems that may arise are suggested.

Adult↗
PubMed2002

A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation.

BACKGROUND: Ventricular fibrillation (VF) remains the most salvageable rhythm in patients suffering a cardiopulmonary arrest (CA). However, outcome remains poor if there is no response to initial defibrillation. Some evidence suggests that intravenous magnesium may prove to be an effective antiarrhythmic agent in such circumstances. STUDY HYPOTHESIS: Intravenous magnesium sulphate given early in the resuscitation phase for patients in refractory VF (VF after 3 DC shocks) or recurring VF will significantly improve their outcome, defined as a return of spontaneous circulation (ROSC) and discharge from hospital alive. DESIGN: A randomised, double blind, placebo controlled trial. Pre-defined primary and secondary endpoints were ROSC at the scene or in accident and emergency (A&E) and discharge from hospital alive respectively. SETTING, PARTICIPANTS, AND INTERVENTION: Patients in CA with refractory or recurrent VF treated in the prehospital phase by the county emergency medical services and/or in the A&E department. One hundred and five patients with refractory VF were recruited over a 15 month period and randomised to receive either 2-4 g of magnesium sulphate or placebo intravenously. RESULTS: Fifty two patients received magnesium treatment and 53 received placebo. The two groups were matched for most parameters including sex, response time for arrival at scene and airway interventions. There were no significant differences between magnesium and placebo for ROSC at the scene or A&E (17% v 13%). The 4% difference had 95% confidence intervals (CI) ranging from -10% to +18%. For patients being alive to discharge from hospital (4% v 2%) the difference was 2% (95% CI -7% to +11%). After adjustment for potential confounding variables (age, witnessed arrest, bystander cardiopulmonary resuscitation and system response time), the odds ratio (95% CI) for ROSC in patients treated with magnesium as compared with placebo was 1.69 (0.54 to 5.30). CONCLUSION: Intravenous magnesium given early in patients suffering CA with refractory or recurrent VF did not significantly improve the proportion with a ROSC or who were discharged from hospital alive.

Aged↗
PubMed2002

Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom.

OBJECTIVE: To develop consensus opinion on future design characteristics of Emergency Medical Services (EMS) systems in the UK with particular regard to advanced life support skills (ALS). DESIGN: A Delphi questionnaire design with two rounds to gain a consensus of opinion. Investigation of four aspects of EMS design is reported-type of response to a priority based dispatch category, transportation options, enhancement of paramedic skills, and structure of a first responder system. SUBJECTS: Chief executives, directors of operations, and medical directors of Ambulance Trusts in the United Kingdom. OUTCOME MEASURES: Likert scales (0-9) to score opinion on a series of statements with achievement of inter-round consistency. A median score of 0-4 was classified as disagreement and 6-9 as agreement. RESULTS: A 65% response to the first questionnaire and with iteration, 52% response to the second questionnaire was attained. A tiered response (paramedics, technicians, and basic life support first responders) with technicians responding to selected category A and B calls and all category C calls (median score (MS) 7.5, interquartile range (IQR) 4), was recommended. Inter-unit handover of selected calls to maintain paramedic availablity ( MS 7.5, IQR 3.75) and enhancement of paramedic skills (MS 7.0, IQR 4.0) was also proposed. Finally, the development of a first responder system fully integrated into the EMS (MS 8.0, IQR 2.75) involving other agencies including the police force, fire service, and trained members of the local community was agreed. CONCLUSIONS: Senior expert staff from Ambulance Trusts in the UK achieved consensus on certain design characteristics of EMS systems. These are significantly different from the present EMS model.

Administrative Personnel↗
PubMed2000

Audit of time to emergency trauma laparotomy.

BACKGROUND: An analysis of the process of care may improve quality of care within a trauma system. Early operative control of haemorrhage is vital and any delay before surgery may adversely affect outcome. METHODS: Times from activation of the aeromedical team to arrival in the emergency department and the operating room for patients with liver or spleen injury were analysed to identify factors that delayed laparotomy. These results were compared with those of a national database. RESULTS: The median time from emergency call to operation was 127 min (140 min for blunt and 86 min for penetrating injuries). Time from arrival in the emergency department to the operating room was 54 min (56 min for blunt and 37 min for penetrating injuries). An audit filter, set at the upper quartile of the emergency call to operating room time, selected 21 patients whose records were examined; five correctable delays were identified. Compared with the national trauma database, these patients had longer on-scene times, but significantly shorter times to operation from the emergency call (127 versus 161 min) and arrival at the emergency department (54 versus 115 min), although the patients were more severely injured (median Injury Severity Score 34 versus 24). CONCLUSION: The time to emergency trauma laparotomy may be used effectively as an audit of process for the clinical governance of a trauma system. Presented to the British Trauma Society, Bath, October 1997 and the Faculty of Accident and Emergency Medicine, Glasgow, December 1997, and published in abstract form as J Accid Emerg Med 1998; 15: 134

Adult↗
PubMed1998

Long-term morbidity in patients suffering a sternal fracture following discharge from the A and E department.

OBJECTIVE: To describe the duration of symptoms and long term outcome in patients who were discharged home from the A and E department having sustained an isolated fracture of the sternum. DESIGN: Postal questionnaire. OUTCOME MEASURES: Patients were asked specific questions regarding advice and analgesia given on discharge, length of time off work, if appropriate, and length of time of symptoms related to the injury. RESULTS: A response rate of 55% was achieved. The majority of patients had been involved in a motor vehicle accident. Chest pain was the predominant persisting symptom lasting for a mean period of 10.9 weeks. Duration of symptoms was significantly prolonged in patients over the age of 50 (p < 0.03). Although injury was more common in females this was not statistically significant (p < 0.09). Advice given regarding rehabilitation was poor and variable. CONCLUSION: Patients suffering a sternal fracture have prolonged symptoms. Those being discharged home from the A and E department are at present being given variable and poor advice. A more formal approach to rehabilitation, analgesia and a letter to the general practitioner outlining prognosis will improve their standard of care.

Accidents, Traffic↗
PubMed1997

Use and effect of paediatric advanced life support skills for paediatric arrest in the A&E department.

OBJECTIVES: To define the use of paediatric advanced life support by the Leicestershire Ambulance and Paramedic Service (LAPS) and the A&E department of a large university teaching hospital; and to identify the outcome and determine the factors that are consistent with a successful outcome. SUBJECTS AND METHODS: The prehospital, accident and emergency (A&E), and inpatient notes of all patients aged 0-16 years who had been admitted to the resuscitation room at the Leicester Royal Infirmary in cardiac arrest between 1 January 1992 and 31 December 1995 were reviewed. Cardiac arrest was defined according to the Utstein template for reporting of prehospital data. RESULTS: During the four year period, 51 cases of paediatric cardiac arrest were identified, with a median age of 3.2 years (range two days to 15 years). In eight patients, resuscitation was not attempted. Of the remaining 43, 15 (37%) were discharged from A&E to the intensive care unit. Five (11.5%) ultimately survived to discharge from hospital. Subsequent neurological development was recorded as normal in four of the five. Of the patients who had a prehospital cardiac arrest and were initially resuscitated by the LAPS there was only one survivor. He was discharged from hospital with severe neurological injury and died three months later. CONCLUSIONS: The outcome for established prehospital paediatric cardiac arrest, in a well defined emergency medical services system, is very poor at present. It does not seem to be affected by the institution of paediatric life support teaching programmes for hospital staff alone. The timing in instituting advanced life support measures remains the most critical factor affecting outcome in these patients.

Adolescent↗
PubMed1996

Prehospital cardiac arrest in Leicestershire: targeting areas for improvement.

OBJECTIVE: To identify the impact of advanced life support skills on outcome for prehospital cardiac arrest in a defined population and to assess the value of certain physiological variables in predicting the outcome in those successfully resuscitated in the accident and emergency (A&E) department; to identify areas for improvement in the outcome of such patients. DESIGN: Prospective 12 month study. SETTING: Leicestershire, United Kingdom. MAIN OUTCOME MEASURE: Survival to hospital discharge and status at 6 months. RESULTS: 266 patients were identified as having suffered a prehospital cardiac arrest; of these, 86 had their resuscitation attempt terminated in the community by a general practitioner and 180 were transferred to the A&E department of the Leicester Royal Infirmary. Of the latter, 159 were felt to be of cardiac aetiology, and 19 were eventually discharged from hospital. All survivors had experienced a witnessed cardiac arrest, ventricular fibrillation (VF) being identified as the initial rhythm. After adjusting for age and sex using logistic regression, the Glasgow coma score (GCS) was found to be associated with subsequent mortality (chi 2 = 18.22 on 2 df, P < 0.0001). Compared to a baseline GCS of 9-15, the relative odds of death for a GCS of 3 were 25.3 (95% confidence interval 4.3 to 149-9), while a GCS of 4-8 gave a relative odds of death of 12-18 (95% CI 1.8 to 80.2). No significant association was found between postarrest arterial pH and mortality. CONCLUSIONS: The immediate GCS on admission is a predictor of outcome and it is important to monitor its trend in the first 24 h. Multidisciplinary audit and joint guidelines with other specialties are important in optimising the care of these patients.

Emergency Medical Services↗
PubMed1996

Diagnostic indicators in the early recognition of severe cocaine intoxication.

Acute cocaine intoxication is an ever increasing problem in the United Kingdom. Aggressive resuscitation linked to early diagnosis is essential in preventing death. Three cases of severe cocaine toxicity are presented to highlight certain diagnostic indicators in recognising the condition in patients presenting in a collapsed state to the accident and emergency department. Acidosis was a striking feature. The acute management of such patients is supportive and should involve methods to minimize continuing absorption.

Acidosis↗
PubMed1996

Role of the accident and emergency department in the non-heart-beating donor programme in Leicester.

OBJECTIVE: To describe the development of a non-heart-beating donor (NHBD) programme in an accident and emergency (A&E) department over a three year period. BACKGROUND AND METHODS: The A&E department at the Leicester Royal Infirmary at present deals with approximately 200 prehospital cardiopulmonary arrests per year. A programme of kidney retrieval from non-heart-beating donors was started in April 1992. Strict criteria for admission to the programme, appropriate consent procedures, facilities, lines of communication, and feedback were developed to enhance its success. RESULTS: Of 66 patients referred to the NHBD programme over a three year period from 1 April 1992, 51 sets of relatives were available to be asked for possible organ donation, and 34 sets (66%) gave their consent. Twenty five patients had successful in situ perfusion of the kidneys. Forty seven organs were retrieved and 34 went on to be transplanted. To date, 27 kidneys are still working. As a result, 23.8% of kidneys transplanted in Leicester over this time period have been from the NHBD programme. CONCLUSIONS: The NHBD programme in Leicester has proved very successful, requiring organisation of resources and personnel both from the transplant service and the A&E department. The programme has provided such a significant boost to the renal transplant rate in Leicester that other hospitals with large A&E departments should consider setting up similar programmes.

Emergency Service, Hospital↗
PubMed1995

Iris dialysis and retinal dialysis caused by coin throwing.

A 13-year old boy was hit in the right eye by a coin that was thrown at him. He presented to the accident and emergency (A&E) department with an oblique corneal abrasion, microscopic hyphaema, iris-ciliary body dialysis, commotio retinae with retinal haemorrhages and a large retinal dialysis. The limited amount of available data in the medical literature suggests that eye injuries as a result of coin throwing are serious and should always be referred to an ophthalmologist for evaluation.

Adolescent↗