Pulse oximetry in the emergency department

Three cases representing the emergency department use of pulse oximetry are described. A brief review of the principles of operation of pulse oximetry, as well as a discussion of recent literature and clinical uses of the technology, is presented. While not replacing arterial blood gases in the assessment of critically ill patients, a more widespread use of pulse oximetry in evaluating emergency department patients might provide significant information in the management of patients with respiratory complaints. Pulse oximetry may also play an important role in monitoring those patients requiring airway interventions such as assisted ventilation or endotracheal intubation.     

The role of pulse oximetry in the accident and emergency department.

Prompt recognition and treatment of hypoxia is an important part of management in the accident and emergency (A & E) department. Until recently the only reliable method of detecting hypoxia was by estimation of the arterial blood gases (ABG). Continuous monitoring of the arterial oxygen saturation (Sao2) is possible using an infra-red pulse oximeter. This study assessed the usefulness of this instrument in the A&E setting. The Sao2 was measured in 50 patients using a pulse oximeter. In 15 patients simultaneous ABG estimations were obtained. The Sao2 correlated closely with calculated values for Sao2. The use of the oximeter identified 21 patients (42%) with clinically unsuspected hypoxia. The pulse oximeter proved simple to use, accurate and a useful addition to our resuscitation equipment.     

Diphtheria presenting in the accident and emergency department.

A case of diphtheria encountered in the accident and emergency department is described. In addition, 38 cases of diphtheria have been analysed, and demonstrate that, although now rare in this country, the disease still exists and its clinical features remain unchanged. It presents almost as often in the accident and emergency department as it does to the general practitioner and remains overwhelmingly a disease of children. Diphtheria is still a notifiable disease. The diagnosis must be made clinically and appropriate action taken before the bacteriological confirmation is received. This prevents unnecessary delay in treatment and makes contact tracing less arduous.     

Nurse practitioners in the accident and emergency department.

The theoretical management of walking wounded patients by experienced nurses was compared with that of middle-grade doctors. Out of 400 patients seen, 332 were assessed by the nurses. The theoretical management by the nurses of 298 of these patients was satisfactory. The nurses mismanaged 12 of the patients according to local practice. They also requested X-rays in 22 more patients than the doctors, none of whom returned with a fracture. Out of the patients suitable to be seen by the nurses 94% said that they would use a nurse practitioner system if introduced. The theoretical waiting-time saving for the patients during the trial was 11 min. The authors recommend that if nurse practitioners are introduced in this country there should be an adequate training programme along nationally debated guidelines.     

HIV malingering in the accident and emergency department.

This paper reports a number of cases of patients attending an accident and emergency (A&E) department claiming to be HIV positive when they have been tested negative and are known to be negative by other departments in the hospital. The reasons for these patients claims are not always apparent. These patients may place an inappropriate workload on an already busy department. We caution doctors working in A&E departments to be vigilant when dealing with patients who claim to be HIV positive when there are no clinical or laboratory findings to substantiate the claim and we recommend liaison between relevant departments within a hospital and the patient's general practitioner (GP) when dealing with these patients.     

The vagrant in the accident and emergency department.

Those of no fixed abode constituted only 0.3% of all new patients seen in one year. The majority presented with a disorder due to acute medical illness or trauma. This group has poor access to general practitioners, and turns to the accident and emergency department for medical care. However, the number of investigations performed and the number admitted to hospital indicate a substantial amount of serious pathology. The proportion of homeless attenders abusing the accident and emergency facilities is small.     

Violence in the accident and emergency department

A survey of Accident and Emergency nurses was undertaken to study the prevalence, types and possible precipitating factors of violence in the workplace. Violence was sub-divided into physical and verbal. Verbal violence was more common than physical assault but often not reported. Often physical violence is under-reported but in fact had affected one third of respondents. Associations with different types of violence are discussed. The need for further training in defusing violent situations and analysis of violent incidents is identified. Some suggestions for inclusion in a training programme are given.     

HIV in the accident and emergency department

This article is intended as an introduction to some of the issues which arise from the increasing incidence in the UK of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). It is not possible fully to address, nor offer answers to, all of these issues. HIV and AIDS present many challenges to nurses. It tests not only our skills and methods of practice, but confronts our feelings about people whose lifestyles and behaviours may be different from our own (Lert & Marne 1992; McGrath et al 1993); it has also prompted us to alter our awareness and knowledge of medical, nursing and infection control issues. Hopefully this article will serve to stimulate reflection, thought and discussion as well as generating further, more specific papers of relevance to the Accident and Emergency nurse.