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Moulton C, Dark P. Sevoflurane. J Accid Emerg Med 1998; 15:207-8. [PMID: 9639196 PMCID: PMC1343076 DOI: 10.1136/emj.15.3.207-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Moulton C. Handbook of Emergency Medicine. Arch Emerg Med 1996. [DOI: 10.1136/emj.13.1.71-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
How unconscious does a patient need to be, to be intubated without drugs? In 76 comatose patients (Glasgow coma score [GCS] < or = 8) who were treated consecutively in an emergency department, the integrity of the cough reflex was not related to GCS. All comatose patients must be treated as if their airway is compromised but even at the lowest coma scores, there are many patients whose airway reflexes are sufficiently intact to make procedures such as endotracheal intubation difficult and dangerous without drugs. The state of the airway should be assessed independently of conscious level.
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McGarry GW, Moulton C. The first aid management of epistaxis by accident and emergency department staff. Arch Emerg Med 1993; 10:298-300. [PMID: 8110319 PMCID: PMC1286036 DOI: 10.1136/emj.10.4.298] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Most nose bleeds can be controlled by compressing the ala nasi, thus applying direct pressure over Little's area. The ability to demonstrate the correct position for this manoeuvre was assessed in 115 members of the staff of the accident and emergency (A&E) department of a major teaching hospital. Overall, the correct response rate was only 33% and even trained medical and nursing staff achieved less than a 50% success rate. Increased awareness of this simple and effective technique is recommended.
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Pennycook A, Makower R, Brewer A, Moulton C, Crawford R. The Management of Dental Problems Presenting to an Accident and Emergency Department. Med Chir Trans 1993; 86:702-3. [PMID: 8308809 PMCID: PMC1294360 DOI: 10.1177/014107689308601210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with dental diagnoses, not necessarily traumatic, often present to accident and emergency departments and general medical practitioners. Few doctors have received much, if any, education in the management of these patients. A 6 month prospective study revealed 107 patients (0.3% of new attenders) attending the accident and emergency department of Glasgow Royal Infirmary. Only 19 of these had suffered trauma. Medical staff in the department were only rarely able to make any diagnosis, and management of these patients took place on an empirical, symptomatic basis. Management could be improved by better education of medical students and doctors. Use of an algorithm may be appropriate.
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Cusack S, Moulton C, Swann IJ. The introduction of automatic blood pressure monitoring to an accident & emergency resuscitation room. Arch Emerg Med 1993; 10:39-42. [PMID: 8452612 PMCID: PMC1285923 DOI: 10.1136/emj.10.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Machines for automatic non-invasive blood pressure (BP) monitoring are increasingly available in British accident and emergency departments. Our department recently acquired two machines with this capability for use in the resuscitation room. This provided us with an opportunity to compare the speed and frequency of automatic BP recording with the previously used manual method. We found no significant difference in either the median time to the first recording of BP or in the median number of documented recordings in the first hour. However, the overall frequency of BP recording did show a statistically significant increase. We conclude that automation alone does not improve standard practice in this area greatly.
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Moulton C, Griffiths PD. The Adequacy of Cervical Spine Radiographs in the Accident and Emergency Department. Med Chir Trans 1993; 86:141-3. [PMID: 8459376 PMCID: PMC1293902 DOI: 10.1177/014107689308600308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One hundred and twenty radiographs of the cervical spine were performed at the request of the Accident and Emergency (A & E) department over a 6 week period. These consecutive films were reviewed for adequacy of anatomical demonstration of the complete cervical spine. The initial series of three films presented to the A & E staff achieved this objective in only 55% of cases overall, although further radiographic examinations requested before the patient left the department raised this figure to 75% for the lateral view and to 70% for the combined anteroposterior (AP) views. From the data it can be predicted that if every patient whose first 3 films were inadequate had received further investigation, the cervical spine would have been well visualized on approximately 90% of radiographs in each plane. The availability of radiologists for advice and their involvement with senior A & E staff in teaching are important factors in improving this situation.
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Croft KD, Dimmitt SB, Moulton C, Beilin LJ. Low density lipoprotein composition and oxidizability in coronary disease — apparent favourable effect of beta blockers. Atherosclerosis 1992; 97:123-30. [PMID: 1361323 DOI: 10.1016/0021-9150(92)90125-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The oxidative modification of LDL in vivo may have an important role in atherogenesis. To determine whether LDL fatty acid, anti-oxidant composition and sensitivity to oxidation in vitro is different in subjects with established atherosclerosis we compared 20 men with angiogram proven coronary disease with 25 controls without clinical evidence of arterial disease. LDL-cholesterol, total triglycerides and LDL fatty acid composition did not differ significantly between the groups. LDL oxidation lag time and oxidation rate in coronary patients (132 min, 0.02 absorbance units/min) and controls (140, 0.017) were not significantly different. However coronary disease subjects taking beta-blockers had evidence for reduced LDL oxidizability (lag time 148 +/- 7 min; oxidation rate 0.017 +/- 0.002 abs units/min) compared with those not on beta-blockers (lag time 114 +/- 7 min, rate 0.025 +/- 0.003, P < 0.005). LDL beta-carotene was significantly lower in coronary patients (0.92 mumol/mmol LDL cholesterol; controls 1.58; P = 0.001). LDL alpha-tocopherol appeared lower in coronary patients (2.8 mumol/mmol LDL cholesterol; controls 3.3; P = 0.056) and was significantly lower in smokers (2.56; non-smokers 3.24; P = 0.04). LDL oxidation rate was negatively correlated with LDL alpha-tocopherol (r = -0.51, P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Moulton C, Pennycook A, Crawford R. Intracardiac therapy following emergency thoracotomy in the accident and emergency department: an experimental model. Arch Emerg Med 1992; 9:190-5. [PMID: 1388495 PMCID: PMC1285859 DOI: 10.1136/emj.9.2.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
For a select group of patients with penetrating chest trauma, immediate thoracotomy in the accident and emergency department offers the only chance of survival. Foley catheters have been used to achieve haemostasis in cardiac wounds but are not widely used for intracardiac fluid and drug administration during resuscitation. In an anatomical model designed to assess this procedure an average flow rate of 275 ml min-1 was achieved. The equipment required is readily available and easily assembled.
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Moulton C. Sudden infant death syndrome. Br J Gen Pract 1992; 42:216-7. [PMID: 1389442 PMCID: PMC1372037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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39
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Moulton C. Linking gag reflexes to the Glasgow coma scale. NURSING TIMES 1992; 88:55. [PMID: 1561141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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40
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Makower RM, Pennycook AG, Moulton C. Intravenous drug abusers attending an inner city accident and emergency department. Arch Emerg Med 1992; 9:32-9. [PMID: 1567526 PMCID: PMC1285824 DOI: 10.1136/emj.9.1.32] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a 3-month prospective study, intravenous drug abusers represented 1.14% of all new attendances at Glasgow Royal Infirmary. They generated a significant workload and were often difficult to identify. A very high proportion required surgery or other invasive procedures. The clinical and epidemiological characteristics of the patients were often unexpected. The risks to staff and other implications for the A&E department are discussed.
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Moulton C, Pennycook A. Coroners, procurators fiscal, and deaths from coronary heart disease. Lancet 1991; 338:1336-7. [PMID: 1682717 DOI: 10.1016/0140-6736(91)92639-j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moulton C, Pennycook A, Makower R. Relation between Glasgow coma scale and the gag reflex. BMJ (CLINICAL RESEARCH ED.) 1991; 303:1240-1. [PMID: 1747645 PMCID: PMC1671555 DOI: 10.1136/bmj.303.6812.1240] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moulton C, Crawford R. Acute laryngeal oedema following self-medication with Chloraseptic. Br J Gen Pract 1991; 41:475. [PMID: 1807310 PMCID: PMC1371794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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46
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Moulton C, Brown N. Sudden infant death syndrome. Br J Gen Pract 1991; 41:431. [PMID: 1777301 PMCID: PMC1371829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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47
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Moulton C. Training in general practice: the other side of the coin. Br J Gen Pract 1991; 41:345. [PMID: 1777286 PMCID: PMC1371763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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48
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Olson PN, Moulton C, Nett TM, Salman MD. Pet overpopulation: a challenge for companion animal veterinarians in the 1990s. J Am Vet Med Assoc 1991; 198:1151-2. [PMID: 2045330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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49
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Moulton C, Wright P, Rindy K. The role of animal shelters in controlling pet overpopulation. J Am Vet Med Assoc 1991; 198:1172-6. [PMID: 2045336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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50
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Eade OE, Moulton C, MacPherson BR, Andre-Ukena SS, Albertini RJ, Beeken WL. Discordant HLA haplotype segregation in familial Crohn's disease. Gastroenterology 1980; 79:271-5. [PMID: 7399230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
To look for possible HLA linkage in familial Crohn's disease, HLA haplotype segregation patterns were determined in 70 members of five kindreds, each having 2 or more patients with Crohn's disease (total number: 13 with Crohn's disease, 1 with ulcerative colitis). Concordant segregation of HLA haplotypes and disease was not observed. Study of HLA A and B locus phenotypes in 64 additional patients with documented Crohn's disease failed to show any significant disease association. We conclude that in these kindreds, HLA linkage does not account for the familial susceptibiltiy to Crohn's disease and that HLA A and B locus antigens are not associated with Crohn's disease.
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