Bjørn Lind

The role of neuroimaging in the initial management of patients with minor head injury.

STUDY OBJECTIVE To determine whether omitting neuroimaging in the primary assessment of patients with minor head injuries in the emergency department is safe. DESIGN Prospective cohort study. SETTING University hospital, Copenhagen County Hospital, Glostrup, Denmark. PARTICIPANTS The study group consisted of 2,204 patients presenting to the ED after sustaining minor head injuries. Only patients able to talk and walk were included. MEASUREMENTS AND MAIN RESULTS The decision to admit was based exclusively on clinical guidelines in which the findings in the ED were of highest priority. Seven patients (0.3%) had a skull radiograph; computed tomography was not used in the primary evaluation. Four hundred thirty patients (19.5%) were admitted. After hospitalization, four patients developed intracranial complications. One required surgery, two required hyperventilation, and one was observed. Follow-up demonstrated that no patient with an intracranial complication had been missed. CONCLUSION We found it safe to exclude neuroimaging in the primary assessment of patients with minor head injuries in the ED, and to rely instead on clinical criteria.

Intensive care: cost and benefit

This study presents a review of 961 patients treated in the general intensive care unit (ICU) of Akershus Central Hospital (ACH) from 1978 to 1981, including also a follow-up study of the 419 patients treated in 1978 and 1979 who were observed for an average period of 20 months after admittance to the ICU. The ICU patients represented 1.7% of all the patients admitted to the referring departments. Approximately 2/3 (67.3%) of the patients were surgical patients, representing 2.9% of the patients treated in that department, 19.6% were medical patients, and 8.6% came from the department of pediatrics. Surgery was the main reason for ICU admittance in 48.1% of the patients; in 70% of these, surgery by itself made postoperative intensive care necessary. Acute or chronic cardiovascular or respiratory disorders caused or contributed to ICU admittance in 78% of the patients; disorders of the nervous system (29.0%), gastrointestinal system (25%), and severe infections (28%) came next. The average stay in the ICU was 6.2 days. The patients need for observation, nursing and therapy was assessed daily according to a care grade scale from 1 to 5, with 5 as maximum effort. The average care grade during the stay, multiplied by the duration of stay in days, gave the care product, which was used as an expression of the patients need for ICU resources. The sum of care products for all the patients through 1 year thus expressed the total work load on the ICU. The ICU budget for 1 year, divided by the total care product for the same year, and thereafter multiplied by the care product for single patients or patient groups, was used as the basis for calculation of ICU costs. Patients receiving mechanical ventilation required 95% of the total work load in the ICU, and 66.3% of these efforts were directly associated with the ventilator treatment period as judged by the care product. Complications to treatment were recorded in 7.3% of the patients, and four of these patients dies of such complications. Improvement by intensive care was achieved in 81.4% of the patients, 5.2% were unchanged, and 13.4% died while in the ICU. Mortality was 9.5% below and 19.3% above the age of 60 years. Of the 419 patients who were followed for an average period of 20 months after admittance to the ICU, 56 died in the ICU, 28 died later during the same stay in ACH, and another 47 died after discharge from ACH, whereas 288 (68.7%) were still alive.(ABSTRACT TRUNCATED AT 400 WORDS)

Predictors of electromechanical dissociation during cardiac arrest

ECG patterns observed during cardiac arrest were analyzed in 261 comatose cardiac arrest survivors. Forty-seven patients (18%) exhibited electromechanical dissociation (EMD) at some point before restoration of stable spontaneous circulation. These patients had a higher mortality (P = .05) and a lower rate of cerebral recovery (P = .01) during the one-year follow-up than study patients who did not exhibit EMD. Patients who developed EMD subsequent to defibrillation had better outcome than patients presenting with EMD. Multivariate analysis revealed that age more than 70 years old (P = .007), pulmonary disease (P less than .001), diabetes (P = .013, in-hospital arrests only), and prearrest hypoxemia (P = .013, outside-hospital arrests only) were independently predictive of the occurrence of EMD. Although the generalizability of these findings is limited, they may offer new clues to the pathophysiology of EMD.

Life-supporting first aid self-training.

The authors studied the acquisition of life-supporting first aid knowledge and skills by 230 lay people in self-training group instruction without qualified first aid instructors and self-training at home. The self-training course consisted of audiotape-recorded instructions, flipover charts, an instruction booklet, first aid materials and a “Resusci Anne®” training mannikin. The same instruction booklet and first aid materials were used for self-training at home. The two teaching systems were equally effective in providing theoretical first aid knowledge, but the course proved superior in teaching practical skills.

CONTROL OF POSTOPERATIVE VOMITING WITH PERPHENAZINE (TRILAFON®): A Double‐Blind Study

The present study demonstrated that perphenazine is a potent antiemetic drug with very few side effects. A single injection of 5 mg of perphenazine reduced postoperative vomiting by half in a series where the anaesthetic agents were mainly nitrous oxide‐oxygen and ether. The effectiveness of this injection exceeded 6 hours and seemed to be sufficient to cover 24 hours. The prolongation of the mean awakening time was 9 minutes, which is of little practical importance.

A COMPARISON OF PETHIDINE AND DIHYDROCODEINE FOR THE RELIEF OF LABOUR PAIN

The pain‐relieving effect of pethidine 100 mg and dihydrocodeine 30 mg was investigated in 419 women during labour pain in three hospitals.