Essential Accident and Emergency Care PDF
Preview Essential Accident and Emergency Care
Essential Accident and Emergency Care Essential Accident and Emergency Care F. Wilson V. W. Burton A. H. Davies A. Kilpatrick M. B. McIllmurray J. E. Pring ~ MTPPRE:5s LIMITED" LA:"ICASTER" [NGLAND Intmwtiol1ld MediCtl/ nd"is/wn Published by MTP Press Limited Lancaster, England Copyright © MTP Press Limited First published 1981 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. British Library Cataloguing in Publication Data Wilson, Frank Essential accident and emergency care. 1. Emergency medicine 1. Title 616'.025 RC86.7 ISBN-13: 978-0-85200-307-7 e-ISBN-13: 978-94-011-6241-8 DOl: 10.1007/978-94-011-6241-8 Phototypesetting by Swiftpages Ltd., Liverpool Contents Contributors vii Acknowledgements viii Publisher's Note viii Foreword ix Function of the accident and emergency department 1 2 The role of the nurse 6 3 Wounds 12 4 Abdominal emergencies 26 5 Soft tissue injuries 36 6 J oint injuries 47 7 Fractures 58 8 Plaster technique 66 9 Eye injuries 77 10 Ear, nose and throat, and facio-maxillary injuries 84 11 Self-inflicted injuries 92 12 Infections 98 13 Local analgesia 104 14 Blood pressure regulation 118 15 Blood volume maintenance and restoration 130 16 Respiratory physiology 141 17 Respiratory obstruction 165 18 Endotracheal intubation 182 v vi Emergency care 19 Apparatus for general anesthesia 197 20 Care before and after anesthesia 206 21 Stages of anesthesia 212 22 Intravenous anesthesia 216 23 Artificial ventilation 221 24 Partial pressure (tension) and blood gases 232 25 pH 245 26 The unconscious patient 249 27 The patient with chest or esophageal pain 259 28 The breathless patient 265 29 The child patient 270 30 Non-accidental injury to children 277 31 The elderly patient 283 32 The violent patient 288 33 Hospital hoppers and the dead patient 291 Appendix: Adverse reactions to drugs 295 Index 297 Contributors V. W. Burton, MB, ChB, FRCS (Ed.) Consultant Orthopedic Surgeon, Royal Lancaster Infirmary A. H. Davies, MB, BS Senior Casualty Officer, Royal Lancaster Infirmary A. Kilpatrick, BA, DA, LRCP, LRCS, LRFPS Consultant Anesthetist, Royal Lancaster Infirmary M. B. McIllmurray, DM, MRCP Consultant Physician, Royal Lancaster Infirmary J. E. Pring, MB, BS, FFARCS, DA, DRCOG, MRCS, LRCP Senior Anesthetic Registrar, Royal Lancaster Infirmary F. Wilson, MB, BS, FFARCS, DA, DCH Formerly Consultant Anesthetist, Royal Lancaster Infirmary vii Acknowledgements We are grateful to Mr John Normanton for producing the diagrams, to Mr Philip J. Harrison, Senior Medical Photographer, Royal Lancaster Infirmary for producing the photographs, to Miss Margaret Hirst for her infinite patience and help in preparing the manuscript and to Mr David Bloomer and his staff at MTP for their guidance and encourage ment at the various stages of publication. Publisher's note The Publishers would like to acknowledge the help of Dr Wallace Park, a colleague of Frank Wilson at the Royal Lancaster Infirmary. Follow ing Dr Wilson's death Dr Park stepped in to assume editorial respons ibility for the book and his help has been invaluable. Dr Wilson and Dr Park co-authored Basic Resuscitation and Primary Care published by MTP Press in 1980. viii Foreword I felt highly honoured when I was asked to write about the achievements of my late brother, Dr Frank Wilson, MB, BS(Lond.), FFA RCS, DA, DCH, who was the editor of and a contributor to this book. Frank graduated in Medicine at St Bartholomew's Hospital Medical College in 1949 at the early age of 22. Born in Lancaster, his one wish was to return to the North. He held house appointments at Preston, spent his two years of National Service in the Royal Air Force and attained the rank of Squadron Leader. While on National Service, his interests turned to anesthetics, and as Senior Medical Officer on H.M. Troopship 'Devonshire', he developed a love for the sea. Convinced that anesthesia was his career, Frank came to Liverpool and attended the University course in this speciality. The vast experi ence he gained in anesthesia in the Liverpool Hospitals and on the Thoracic, Cardiac, Neurosurgical and Paediatric units, ensured his continued interest in resuscitation and neonatal anesthesia, which led him to design a new tracheostomy tube when he was at Alder Hey Children's Hospital. He became Lecturer in Anesthesia at the University of Liverpool and later Consultant Anesthetist to Southmead Hospital, Bristol, and then to the Burnley group of hospitals and to Lancaster in 1966. Frank always sought the truth. He applied his critical and enquiring mind to his clinical problems and he was not satisfied until he had resolved them in the simplest possible way. This gift and his desire to impart his knowledge and experience to others, led to his enjoyment of teaching, lecturing, writing articles, books and chapters in books in particular for the nursing profession. He developed a highly successful pain clinic in Lancaster and it was stimulating to discuss with him his views on the physiological and pharmacological aspects of pain. His achievements were recognized by his election as President of the Anesthetic Section of the Manchester Medical Society for 1980-81, an office he carried with dignity. Frank was intensely devoted to anesthetics and to his patients but he ix x Emergency care also loved the sea and the hills. As ship's surgeon, he served on many famous Cunard ships, his last trip was on the QE II. The size of the ship did not deter his adventurous spirit, for he enjoyed going out in the lifeboats and became chairman of the local branch of the RNLI. He always enjoyed his walks with the Lancaster Rambling Association and particularly long distance walks which lasted overnight and which he always completed. They included the Four Peaks, the Fellsman and the Dartmoor 100. In spite of his many achievements, Frank loved his home and garden. A bachelor, he lived with his Mother, to whom he was devoted. It is tragic and regretful that he collapsed and died on the hills in the company of his friends only two days after handing the manuscript of this book to the publisher. He will be sadly missed by all who worked with him and knew him. H. Wilson, MD, PhD, MIL Senior Lecturer, Department of Pharmacology, The University, Liverpool 1 Function of the accident and emergency department v. W. BURTON Originally, Accident and Emergency departments were established to treat minor accidents and provide care for patients who were taken suddenly ill. However, recent surveys of patients attending such departments indicate that they are becoming health centres for some groups of the population. Therefore, a wide selection of patients attend these departments ranging from those suffering from minor ailments to those who have been seriously injured and who require resuscitative procedures before being admitted to hospital for definitive treatment. Another group consists of patients who are referred for investigation by their general practitioner to the admitting surgical or medical firm on duty. Frequently there is a delay in obtaining a bed for the patient, and medical staff may find it expedient to retain him in the Accident and Emergency department until an accurate diagnosis has been made, perhaps arranging for his direct transfer to the operating theatre if he is suffering from an acute surgical condition without prior admission to the surgical ward. The Accident and Emergency nurse is therefore involved in the management of patients suffering from a wide range of medical and surgical conditions, including trauma. There are about 20 000 new attendances per year at the Accident and Emergency department in Lancaster. The patients are referred by their personal physicians, attend of their own accord or arrive by ambulance. Their attendance and treatment statistics are listed and discussed below. Attendance profile at the Royal Lancaster Infirmary Accident and Emergency Department Reason for attendance Percentage number of patients Non-accident 41 Sports injury 17
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