Scientific basis for selection of emergency medical examination gloves for emergency medical technicians, paramedics, firefighters, and emergency department personnel

Dusting powders were first applied to gloves to facilitate donning. After 1980, manufacturers devised innovative techniques to manufacture gloves without dusting powders. It has been well documented that the powders on gloves present a health hazard to patients, as well as healthcare workers. First, these powders elicit tissue toxicity in every tissue in the body. Second, these powders serve as carriers of latex allergen and may precipitate a life-threatening allergic reaction in sensitized patients. These well-documented hazards of glove powders have caused a growing number of emergency medical technicians, paramedics, firelighters, and hospitals to abandon the use of powdered emergency medical examination gloves, using only powder-free gloves. Powder-free latex as well as non-latex gloves are now available to emergency medical technicians, paramedics, firefighters, and emergency department personnel. The use of powder-free natural rubber latex-free gloves is especially important to emergency medical technicians, paramedics, firefighters, as well as emergency department personnel to avoid eliciting an allergic reaction in the latex sensitized patient. The majority of our emergency medical technicians, paramedics and firefighters are now wearing powder-free emergency medical examination gloves that comply with the stringent Codes and Standards established by the National Fire Protection Association (NFPA), while very few hospital emergency department personnel have been provided with NFPA approved gloves. It is the purpose of this report to review the stringent regulations for emergency medical examination gloves that are outlined by the NFPA. This design and performance Standard was devised by the NFPA to address protective clothing for emergency medical operations. The design and performance requirement of the emergency medical examination gloves were described in the NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 1997 Edition. In September 2003, the emergency medical examination glove must meet the new design and performance requirements of emergency medical examination gloves discussed     

Two Major Burn Cases

Case histories of two patients admitted to the Burns Unit in 1976 and 1982, with very extensive and very deep burns, are described. The philosophy behind the usual treatment plan of the Unit and the unorthodox ideas that had to be devised in order to treat the 2 patients are described.     

Two major burn cases

Case histories of two patients admitted to the Burns Unit in 1976 and 1982, with very extensive and very deep burns, are described. The philosophy behind the usual treatment plan of the Unit and the unorthodox ideas that had to be devised in order to treat the 2 patients are described.     

Audit of the effect of a fast tracking protocol on transfer time from A&E to ward for patients with hip fractures

The objective of this project was to study the effect of a "fast tracking protocol" on the time spent in the A&E department by patients with hip fractures. A review of 104 patients with hip fractures admitted via the A&E department between March 1997 and September 1997 (7 months) in a District General Hospital (Alexandra Hospital, Redditch) showed that many patients spent more than 2 h lying on uncomfortable trolleys in the department. A fast tracking protocol was devised for a quicker as well as safe transfer of these patients to the ward. This was implemented from December 1997 and its effects closely monitored on a monthly basis for the next 7 months up to June 1998.Results showed that the fast tracking protocol produced a significant reduction in the time spent in the A&E department by 90 out of the 100 patients with hip fractures. The transfer time (mean+/-SD) before the fast tracking process was 2 h 45 min +/- 57 min (N=104, median=2 h 40 min). After the protocol was implemented this was reduced to 1 h 32 min +/- 40.87 min (N= 90, median= 1 h 25 min). This reduction is statistically significant (p < 0. 001; Student t test). Also, more patients were transferred within the target time of 1 h (24 out of 90 patients) compared with before the introduction of the protocol (3 out of 104 patients). This was also statistically significant (p < 0.001; Chi-square test). Ten out of 100 patients were not fast tracked because of multiple injuries, acute medical problems or inconclusive diagnosis. These patients still spent an average of 2 h 55 min (median 2 h 55 min) in the A&E department. In conclusion, the fast tracking protocol significantly reduces time spent in the A&E department by patients with isolated hip fractures. There is also a significant increase in the number of patients transferred within the hour. This has numerous benefits for the patients as well as the A&E department.     

Treatment of anal stenosis: a 5-year review

BACKGROUND: Benign anal stenosis is an uncommon, disabling and incapacitating disease, occurring mainly after anorectal surgery. Both non-surgical and surgical treatments have been devised in the treatment of anal stenosis with good results. We described the results of the treatment of this disease in the Coloproctology Department of our institution. METHODS: A retrospective clinical study was undertaken over a 5-year period for consecutive patients operated on for anal stenosis. RESULTS: Twenty-three patients with benign anal stenosis were treated in our department. Haemorrhoidectomy was the most common cause of anal stenosis (74%). Nineteen patients with moderate to severe symptoms of anal stenosis underwent surgical treatment. Lateral mucosal advancement flap was the most frequently carried out operation (63.1%). Four patients were treated with anal dilatation (17.3%). All patients had remission of the preoperative symptoms. There was no re-operation and only minor complications were present in four patients: three patients with anal pruritus and one patient with temporary incontinence. CONCLUSION: The easy performance, the absence of major complications and the good results obtained confirm that these methods are effective and safe in the treatment of anal stenosis.     

The da Silva method of incisional hernia repair

A technique of incisional hernia repair originally devised by da Silva is described. The operation was performed on 30 patients and no recurrence was found in the 27 cases examined 1 to 4.5 (mean 2.5) years later.     

History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique

The history of pancreaticojejunostomy in pancreaticoduodenectomy is described. Many types of operations have been devised in search of a more reliable method of anastomosis. To perform a safe and reliable pancreaticoenteric anastomosis it is necessary to understand the organ characteristics of the pancreas. We investigated factors required for a reliable pancreaticojejunostomy and devised a new surgical technique that meets those requirements. We introduce the theoretical substantiation and clinical usefulness of our new surgical technique while reviewing the history of pancreaticojejunostomy after pancreaticoduodenectomy. The unique aspect of our method is approximation of the pancreas stump and jejunal wall by six to eight interrupted sutures. It is speculated that too many sutures and tying too tight in the anastomosis may cause ischemia and necrosis of the pancreatic stump by restricting the tissue blood flow. Our method allows us not only to reduce the number of sutures, but also to avoid some of the complicated manipulations done in any other existing methods. The newly devised pancreaticojejunostomy is an excellent surgical technique with anastomotic failure seen in only two patients and no deaths out of 162 consecutive patients. Received: July 14, 2000 / Accepted: December 22, 2000     

Scientific basis for the selection of emergency medical examination gloves for emergency medical technicians, paramedics, firefighters, and emergency department personnel. An update

The use of powder-free natural rubber or latex-free emergency medical examination gloves is especially important to emergency medical technicians, paramedics, firefighters, and emergency department personnel to avoid eliciting an allergic reaction in the latex sensitized patient. The majority of our emergency medical technicians, paramedics, and firefighters are now wearing powder-free emergency medical examination gloves that comply with the stringent codes and standards established by the National Fire Protection Association (NFPA), while very few hospital emergency department personnel have been provided with NFPA-approved gloves. There are four well-defined goals of this report that will assist emergency medical services, fire departments, and hospitals in the selection and purchase of emergency medical examination gloves. First, we will review again the stringent regulations for emergency medical examination gloves that are outlined by the NFPA. This design and performance standard was devised by the NFPA to address protective clothing for emergency medical operations. The design and performance requirement of the emergency medical examination gloves were described in the NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 1997 Edition. As of September 2003, the emergency medical examination glove must meet the new design and performance requirements of emergency medical examination gloves discussed in NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 2003 Edition.     

Modified Fogarty Clamp for the Fragile Aorta

The Fogarty aortic hydragrip clamp is adequate to clamp the normal aorta during open-heart operation. The fragile aorta, however, requires a more delicate occlusion than that provided by the slim, rather rigid clamping jaws of the Fogarty clamp. To prevent the crushing effect of a Fogarty clamp on a fragile aorta, a simple modification has been devised and is described here.     

The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Background

The fastest growing segment of the American population is the elderly (>65 years). This change in demographics also is being seen in trauma centers. Emergency department thoracotomy is utilized in an attempt to restore circulation for patients arriving in extremis. The purpose of this study was to investigate the relationship between clinical variables, particularly age, and outcomes for injured patients receiving an emergency department thoracotomy.

Improved results of surgery for esophageal carcinoma in 148 patients

Since the late 1970's, there has been a remarkable decrease in the mortality of patients with esophageal cancer. Factors such as progress in pre- and post-operative management, operative technique, and anesthesia all play a contributory role in this improvement. Among 251 Japanese patients with esophageal carcinoma who underwent esophageal resection and reconstruction in our department of surgery since 1965, those treated from 1965–74 and others treated from 1975–1984 were investigated in detail. It became clear that pulmonary complications and anastomotic leakage were the two major complications related to operative mortality. The former has decreased by intensive postoperative care with strong emphasis on cough dynamics, and the latter because of the long gastric tube we devised and which has a good blood supply. These positive events make feasible early postoperative irradiation and cancer chemotherapy.     

Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty

The aim of this study was to assess the diagnostic accuracy of radiology department-based hip aspiration for the diagnosis of infection after total hip arthroplasty. Patient selection criteria were devised so that only patients with moderate to high risk of infection were selected for hip aspiration. Seventy-three patients are included in this study, all of whom underwent revision hip surgery after aspiration. Culture results of hip aspirates were compared with the intraoperative tissue cultures at the time of revision surgery, which was used as the gold standard for diagnosing infection. Seventeen patients (23%) had infected hip joints at operative culture. The sensitivity and specificity, positive and negative predictive values, and accuracy of the hip aspiration were 0.82 and 0.91, 0.74 and 0.94, and 0.89, respectively. We conclude that hip aspiration carried out in the radiology department is reliable, but appropriate patient selection is important to obtain accurate results.     

Direct access surgery.

Evolving surgical practice in the UK is imposing increasing pressures on surgical outpatient clinics. A Direct Access Surgery (DAS) programme was evaluated in which otherwise healthy patients with simple surgical conditions presenting little diagnostic difficulty were referred directly to hospital for surgical operation without attending the outpatient department. Specific referral criteria for DAS were devised. Appropriate surgical conditions or procedures included hernias, vasectomies, cystic scrotal swellings, subcutaneous lumps and skin lesions, symptomatic gallstones, varicose veins and ingrowing toenails. Over a 12 month period, 105 patients were referred for DAS and 102 underwent operation. There was a low incidence of inaccurate diagnosis (< 2%) and inappropriate referral (< 1%). DAS was well received by both General Practitioners (GPs) and patients. Implementation of such programmes may result in considerable savings of outpatient time and resources.     

Correction of Prominent Ears with a New Splinting Technique

Correction of prominent ears represents one of the main applications in plastic surgery. Apart from its cosmetic nature, this operation is important because of the psychological distress that the deformity causes patients. In this study, 40 patients who underwent treatment for prominent ears in our department were evaluated. The classical surgical technique described by Chongchet followed by a new splinting procedure was performed. The advantages of this technique are described in comparison with traditional methods.     

Bilateral Wyburn-Mason syndrome presenting as acute subarachnoid haemorrhage – a very rare congenital neurocutaneuos disorder

A 30 year old young male was admitted to our department after experiencing clinical symptoms of a subarachnoid haemorrhage. Imaging studies revealed large cerebral AVMs. Fundus examination of the left eye demonstrated a retinal racemose AVM almost completely covering the posterior pole of the eye. Wyburn-Mason syndrome is a very rare congenital neurocutaneous disorder comprising of vascular malformations of the retina, ipsilateral cerebral AVMs and occasionally lesions in the oronasopharyngeal area. Subarachnoid haemorrhage associated with Wyburn-Mason syndrome has been described in only 5 patients in the literature since 1973. The finding of retinal AVMs should warrant cerebral imaging studies including CT- or MR-angiography.     

Hickman catheter placement simplified

A simplified technique to place the Hickman indwelling right atrial catheter has been devised. This involves securing the catheter to a trocar, which is easily advanced to the cutdown site of the selected vein. Experience in more than 75 patients shows this technique to be associated with less discomfort and fewer complications than seen with standard techniques.     

The treatment of small burns with a chlorhexidine-medicated tulle gras

The effect of a tulle gras dressing medicated with chlorhexidine was shown to reduce significantly the incidence of Staphylococcus aureus in experimental burns made on guinea-pigs. This dressing apparently did not interfere with wound healing.

A controlled clinical trial is described which compared the effects of non-medicated tulle gras with tulle gras containing 0.5 per cent chlorhexidine on the incidence of S. aureus and other bacteria in burns treated in an outpatient department. The medicated dressing significantly reduced the incidence of S. aureus in these wounds. A high proportion of antibiotic-resistant staphylococci were isolated from patients in the trial; the value of chlorhexidine in this situation is discussed.     

The use of prosthetic material in rectopexies

Among the 80 different techniques that have been devised to repair rectal prolapse, abdominal rectopexies are the most suitable. The majority of these operations secure the rectum to the sacrum by means of a prosthetic material. Ripstein's technique, in USA, and Wells procedure, in Great Britain, have gained wide acceptance, despite a rather high rate of complications. A modified technique has been recently proposed by Keighley et al., with excellent results. From 1979 to 1982, 20 patients were operated upon in our department for rectal prolapse. The mean age of the patients was 43 years, and there was a rather high percentage of male patients (30%). Eleven exhibited an obvious external prolapse patients (30%). Eleven exhibited an obvious external prolapse but the others complained of the "occult rectal prolapse syndrome". The Orr-Loygue procedure, that secures the rectum to the sacral promontory by means of two strips of nylon mesh, was performed in all these cases. No mortality was observed and the morbidity was minimal. No infectious complications occurred. The procedure was performed without sexual consequences in the young patients. Clinical, endoscopic and cineradiographic checks illustrate that the Orr-Loygue rectopexy is an efficient treatment of both incipient intussusception and external prolapse, and offers good control of most associated troubles. But a longer survey is necessary before definitive conclusions may be drawn.     

Cardiovascular effects of increased intra-abdominal pressure in newborn piglets

An experimental model for measuring the cardiovascular effects of increased intra-abdominal pressure was devised and described. Aortic and pulmonary artery pressures were found not to vary with increasing intra-abdominal pressure. The pH, pCO₂, and pO₂ were measured from the aorta, pulmonary artery, and inferior vena cava. No statistical difference in these parameters could be found with increasing intra-abdominal pressure. Cardiac output and cardic index decreased sharply with increasing intra-abdominal pressure. These data emphasize the importance of intra-abdominal pressure on cardiovascular function in newborn animals.