Journal ofAccident J7anuary 1998, Volume 15, Number 1 & Emergency Medicine

Review articles 2 How should we manage exsanguinating pelvic fractures in the United Kingdom? S Meek, R Ross

7 Anterior glenohumeral dislocations: what to do and how to do it A P Gleeson J Accid Emerg Med: first published as on 1 January 1998. Downloaded from Original articles 13 The impact of nationally distributed guidelines on the management of paracetamol poisoning in accident and emergency departments M C Bialas, R J Evans, A D Hutchings, G Alldridge, PA Routledge 18 Deliberate self harm assessment by accident and emergency staff-an intervention study M J Crawford, G Turnbull, S Wessely 23 Restricting extensions to permitted licensing hours does not influence the numbers of alcohol or assault related attendances at an inner city accident and emergency department C A Graham, L S McLeod, D Jf Steedman 26 Role of the short stay observation ward in accident and emergency departments in the United Kingdom S W Goodacre 31 Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey C C Tye, F Ross, S M Kerry 35 A profile of sports hand injuries in an accident and emergency department M Q Choyce, M Potts, A K Maitra Viewpoint 39 Vulnerability, victims and violence J P Shepherd, F P Rivara Research 46 Future strategy for United Kingdom research in accident and emergency medicine B A Foix, F E Lecky,J P Wyatt For debate 49 So many unanswered questions: the emergency care system of the future D Pencheon, M Lambert, P Hadridge Case reports 54 Gastric evacuation for acute ethanol intoxication in a three year old S Z Hussain, J Rawal, J A Henry 56 CS gas exposure in a crowded night club: the consequences for an accident and emergency department A Breakell, G G Bodiwala http://emj.bmj.com/ 58 Symmetrical necrotising chest wall infection following paronychia PE Banwell, Jf Pereira, B WE M Powell 59 Infratemporal and temporal fossa abscess complicating dental extraction M S Diacono, A R Wass Management issues 63 Complaints-and how to deal with them G Bryce on September 29, 2021 by guest. Protected copyright. Journal scan 65 Obituaries 67 Mary Sheila Christian; Philip Hedley Brackenbury Letters to the editor 69 Resuscitation from hypothermia T T Parke; reply A J Ireland, VL Pathi, R Crawford, I W Colquhoun 69 Treatment of focal status epilepticus with lignocaine D Emerton; reply H Kato, H Fujita, H Kishikawa, S Emura, T Takashima, K Ohmori 69 Alcohol intoxication in a toddler C Tovey, P SJ B Rana, D JrAnderson 70 More alcohol Z Denning 70 Intrasound for ankle injuries A S Lockey, S M Barnes; reply A Dancocks Emergency 22 Motorbike toe: a toddler's sporting injury S Kane casebook 62 Orbital pseudotumour in the differential diagnosis of eyelid swelling M Ramchandani, G Nahhas VOLUME 15 * CONTENTS

No 1 JANUARY 1998 Review articles 2 How should we manage exsanguinating pelvic fractures in the United Kingdom? J Accid Emerg Med: first published as on 1 January 1998. Downloaded from S Meek, R Ross 7 Anterior glenohumeral dislocations: what to do and how to do it A P Gleeson Original articles 13 The impact of nationally distributed guidelines on the management of paracetamol poisoning in accident and emergency departments M C Bialas, R Jf Evans, A D Hutchings, G Alldridge, PA Routledge 18 Deliberate self harm assessment by accident and emergency staff-an intervention study M Jf Crawford, G Turnbull, S Wessely 23 Restricting extensions to permitted licensing hours does not influence the numbers of alcohol or assault related attendances at an inner city accident and emergency department C A Graham, L S McLeod, D J Steedman 26 Role of the short stay observation ward in accident and emergency departments in the United Kingdom S W Goodacre 31 Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey C C Tye, F Ross, S M Kerry 35 A profile of sports hand injuries in an accident and emergency department M Q Choyce, M Potts, A KMaitra Viewpoint 39 Vulnerability, victims and violence Jf P Shepherd, F P Rivara Research 46 Future strategy for United Kingdom research in accident and emergency medicine B A Foex, FE Lecky, Jf P Wyatt For debate 49 So many unanswered questions: the emergency care system of the future D Pencheon, M Lambert, P Hadridge Case reports 54 Gastric evacuation for acute ethanol intoxication in a three year old S Z Hussain,Jf Rawal,

JA Henry http://emj.bmj.com/ 56 CS gas exposure in a crowded night club: the consequences for an accident and emergency department A Breakell, G G Bodiwala 58 Symmetrical necrotising chest wall infection following paronychia P E Banwell, Jf Pereira, B WEM Powell 59 Infratemporal and temporal fossa abscess complicating dental extraction M S Diacono, A R Wass

Management issues on September 29, 2021 by guest. Protected copyright. 63 Complaints-and how to deal with them G Bryce 65 Journal scan Obituaries 67 Mary Sheila Christian; Philip Hedley Brackenbury Letters to the editor 69 Resuscitation from hypothermia T T17 Parke; reply A J Ireland, VL Pathi, R Crawford, I WColquhoun 69 Treatment of focal status epilepticus with lignocaine D Emerton; reply H Kato, H Fujita, H Kishikawa, S Emura, T Takashima, K Ohmori 69 Alcohol intoxication in a toddler C Tovey, P SJ_ B Rana, D JAnderson 70 More alcohol Z Denning 70 Intrasound for ankle injuries A S Lockey, S M Barnes; reply A Dancocks Emergency casebook 22 Motorbike toe: a toddler's sporting injury S Kane 62 Orbital pseudotumour in the differential diagnosis of eyelid swelling M Ramchandani, G Nakhas

No 2 MARCH 1998 Review articles 72 The early management of meningococcal disease TJ7 Hodgetts, A Brett, N Castle 77 The cost of alternative models of care for primary care patients attending accident and emergency departments: a systematic review G M Leydon, R Lawrenson, R Meakin, _JA Roberts 84 The management of minor traumatic brain injury PJA Hutchinson, PJ_ Kirkpatrick, J Addison, SJackson, J D Pickard Current practice 89 Therapeutic controversies in the management of acute anaphylaxis A F T Brown 96 Guidelines for the management of anaphylaxis in the emergency department M Gavalas, A Sadana, S Metcalf

Original articles J Accid Emerg Med: first published as on 1 January 1998. Downloaded from 99 Effects on patient care of introducing prehospital intravenous nalbuphine hydrochloride P Hyland-McGuire, H R Guly 102 Notification of infectious diseases by junior doctors in accident and emergency departments R L Spedding, M G Jenkins, S A O'Reilly 105 Can accident and emergency nurse practitioners interpret radiographs? A multicentre study S Meek, J Kendall, J Porter, R Freij Short reports 108 Use of the spinal board within the accident and emergency department M W Cooke 109 Relatives in the resuscitation room: their point of view F Barratt, D N Wallis i11 Tick bite anaphylaxis in Australia A F T Brown, D L Hamilton Case reports 114 Adult supraglottitis: an important cause of airway obstruction Y Dixon, JJ M Black 115 Breaking the rules! Cardiac injury from remote entry sites VPathi, F WH Sutherland, A Ireland, K G Davidson 116 Conservative management of gastric rupture following scuba divingJT D Hunter, C A Roobottom, PJ Bryson, C Brown Occasional piece 119 The treatment of head injury during the Renaissance B Nathan, G Evans Management issues 121 How to organise a higher training programme in A&E H R Guly 123 Choosing an accident and emergency department computer system B C Elvin 126 Journal scan Abstracts 129 Scientific Meeting of the Faculty of Accident and Emergency Medicine, Royal College of Physicians and Surgeons, Glasgow, December 5-6, 1997 Letter 140 Measurement of pain in children in the emergency department L Ferguson, T F Beattie

Book review http://emj.bmj.com/ 140 Poisonous Plants in Britain and Ireland (CD-ROM) Emergency casebook 118 Fibular fracture: detection with high resolution diagnostic ultrasound J D Hunter, C Jf Mann, P M Hughes 128 Development of tension pneumothorax after chest drain insertion R C Bailey, D Esberger on September 29, 2021 by guest. Protected copyright. No 3 MAY 1998 Leader 142 The clinical relevance of observational research F E Lecky, PA Driscoll Original articles 147 Analgesia in the accident and emergency department: do SHOs have the knowledge to provide optimal analgesia? S Sandhu, P Driscoll, Y Nancarrow, D McHugh 151 Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer's views? A Y Ireland, I Britton, A W Forrester 155 Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department T W Wong, C C Lau, A Yeung, L Lo, C M Tai 159 The risks of minor head injury in the warfarinised patient A P Volans 162 Aerobic and anaerobic microbiology of infections after trauma in children I Brook 168 Primary care problems in patients attending a semi-rural accident and emergency unit: a prospective study R L Cottingham 170 The work of the American emergency physician J P Wyatt, J E Weber, C Chudnofsky 175 A transatlantic comparison of training in emergency medicine J P Wyatt, Y E Weber For debate 181 Accident and emergency 24 hour senior cover-a necessity or a luxury? M W Cooke, C Kelly, A Khattab, K Lendrum, R Morrell, EJ Rubython Short report 185 The flat electrocardiogram-systole or asystole? R A Cocks, M Thompson, Y WKwan Case reports 187 Spontaneous carotid artery dissection presenting as migraine-a diagnosis not to be missed Z Mirza, P Hayward, D Hulbert 189 Late clotted haemothorax after blunt chest trauma P Sinha, P Sarkar 191 Out of hospital cardiac arrest and associated injury A IJones, MJ Stuart, A Jf Gray 192 Ectopic pregnancy presenting with obturator nerve pain H S Ali 194 Clarithromycin induced digoxin toxicity S P Nordt, S R Williams, A S Manoguerra, R F Clark 196 Caffeine toxicity in a bodybuilder C R FitzSimmons, N Kidner Commentary

200 Accident and Emergency Broadsheet: Undergraduate accident and emergency medicine J Accid Emerg Med: first published as on 1 January 1998. Downloaded from education broadsheet S Tachakra, A Sivakumar, M McCabe Management issues 202 Purchasing new equipment C D H Oakland 203 Disciplinary procedures I P Stewart 205 Journal scan Letters to the editor 207 Anaesthetic for Colles' fracture A Lockey; reply Jf Kendall 207 Sevoflurane C Moulton, P Dark; reply R G Mitchell, N Nichol, 7 Steedrnan, A S Goldie 208 Traumatic pericardial tamponade P E Chiquito, C L Muwanga, R K Banerjee, M ones, D R Parkins 208 SHOs' interpretation of x rays A M Leaman; reply C A Jf McLauchlan 208 Curriculum based teaching M F Nicol, KE ones, M Cameron, 7 Kendall 209 Developments in radiology R Mcglone, S Durham Book review 209 Advanced Paediatric Life Support: The Practical Approach Appreciation 210 Cambridge accident and emergency team wins BUPA communication award Emergency casebook 198 A case of ipsilateral shoulder and elbow dislocation: an easily missed injury F M Ali, S Krishnan, M Jf Farhan 199 Spinal tumour: a diagnostic lesson V Varalakshmi, A Idowu, S Jeevan

No 4 JULY 1998 Reviews 212 Appropriateness of use of emergency ambulances H Snooks, H Wrigley, S George, E Thomas, H Smith, A Glasper 215 Review of a general practice attachment for accident and emergency M A training Howell, http://emj.bmj.com/ S P Cembrowicz, K_Jones Short report 218 General practice: a secondment from emergency medicine-so what! M F Nicol, C A Jf McLauchlan Best evidence in emergency medicine 220 Moving towards evidence based emergency medicine: use of a structured critical appraisal journal club S D Carley, K Mackway-Jones, A Jones, R Jf W S Morton, Dollery, Maurice, on September 29, 2021 by guest. Protected copyright. L Niklaus, S Donnan 222 The best evidence topic report: a modified CAT for summarising the available evidence in emergency medicine KMackway-Jones, S D Carley, R Jf Morton, S Donnan Best evidence topic reports 227 Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary Edited by KMackway-Jones Original articles 231 An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing R G McGlone, S Ranasinghe, S Durham 237 Epilepsy in the accident and emergency department-developing a code of safe practice for adult patients Jf Ryan, S Nash, Jf Lyndon on behalfof the South East and South West Thames Accident and Emergency Specialty Sub-committees 244 Oral midazolam for conscious sedation of children during minor procedures F C Davies, M Waters 249 Prospective study of "door to needle time" in meningococcal disease FA I Riordan, A PJ Thomson,JfA Sills, CA Hart 252 "Not so immediate" hypersensitivity-the danger of biphasic anaphylactic reactions E Brazil, A F MacNamara 254 Clinical impact of blood cultures taken in the emergency department A-M Kelly 257 Recurrent overdose: patient characteristics, habits, and outcomes D McD Taylor, PA Cameron, D Eddey 262 Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland M G Jenkins, L G Rocke, B P McNicholl, D M Hughes 266 Can nurse practitioners offer a quality service? An evaluation of a year's work of a nurse led minor injury unit A F Mabrook, B Dale 269 Subungual haematomas: is simple trephining enough? S Meek, M White 272 Edinburgh's Hogmanay celebrations: beyond a major disaster JJ O'Donnell, A P Gleeson, H Smith Case reports

274 Silent orbitocranial penetration by a pencil S Dinakaran, PJf Noble J Accid Emerg Med: first published as on 1 January 1998. Downloaded from 275 Neurogenic pulmonary oedema G WKerr Abstracts 277 Annual Conference for the British Association for Accident and Emergency Medicine, Birmingham, 29 April to 1 May 1998 Letters to the editor 286 The question of removing a ventilation bag before defibrillation E Cantello, T E Davy, K L Koenig; reply M E Ward 286 Pre-hospital emergency rapid sequence induction of anaesthesia M Speirs, R E Webster; reply C A Graham, A D McR Meyer 287 Use and effect of paediatric life support skills for paediatric arrest I Maconochie, FJewkes 287 Accidental digital injection of adrenaline from an autoinjector device K S Murali, N Nayeem; G Lee, P C Thomas; reply SJ McGovern 287 Nutmeg intoxication G I Quin, N F Fanning, P K Plunkett 288 CS spray M M Stark 288 "Shop hopping" A Fraser-Moodie 289 Book reviews

No 5 SEPTEMBER 1998 Original articles 292 Outpatient management of deep vein thrombosis D F O'Shaughnessy, C Tovey, A L C Miller, V O'Neill, P S Rana, S Akbar, M H Thomas 294 Computed tomography of the head by the accident and emergency department-why 24 hour access is vital A F MacNamara, E Brazil, PA Evans 298 Avoidable deficiencies in the delivery of health care to children with meningococcal disease S Nadel, J Britto, R Booy, I Maconochie, P Habibi, M Levin 304 Non-invasive assessment of cardiac output in children Jf R Richardson, J Ferguson, J Hiscox, J Rawles 308 Emergency intubation of infants: does laryngoscope blade design make any difference? http://emj.bmj.com/ Jf D Whittaker, C Moulton 312 Can x rays be accurately interpreted using a low cost telemedicine system? S O'Reilly, R Spedding, C Dearden, M Loane 315 Use of the Ottawa ankle rules by nurse practitioners C J Mann, I Grant, H Guly, P Hughes 317 British Thoracic Society guidelines for the management of spontaneous pneumothorax: do we comply with them and do they work? T Soulsby 322 "Saturday night fever": ecstasy related problems in a London accident and emergency on September 29, 2021 by guest. Protected copyright. department H Williams, L Dratcu, R Taylor, M Roberts, A Oyefeso 327 Use of an electric ear syringe in the emergency department IJones, C Moulton Short report 329 Perceived contraindications to thrombolytic treatment in acute myocardial infarction. A survey at a teaching hospital D S Wald Case reports 332 Life threatening airway obstruction: a hazard of concealed eating disorders TM ones, L C Luke 333 Serotonin syndrome due to venlafaxine overdose R J Daniels 334 Puffer fish poisoning J Field Clinical management 337 Clinical management-the series Edited byJ Wardrope 337 Investigation of the head injured patient IJ Swann, D HA McCarter 344 Later investigation of head injury IJ Swann, D HA McCarter 349 Journal scan Edited by J Wardrope, coordinated by G Thirumamanivannan Best evidence topic reports 352 Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary Edited by KMackway-Jones Broadsheet 356 Management of sickle cell crisis British Association for Accident and Emergency Medicine Commentary-S S Tachakra, S C Davies Management issues 358 Audit in the accident and emergency department TD Llewellyn Personal view 360 Continuing medical education one year on-how was it for me? C Reid 364 Letters to the editor 366 Corrections Emergency casebooks 297 Tracheal deviation as a sign in ill patients: beware ipsilateral pathology K Graetz,

T Hassan J Accid Emerg Med: first published as on 1 January 1998. Downloaded from 307 Closed digital artery injury A A Faraj, MA Craigen 331 Waldenstr6m macroglobulinaemia presenting as bleeding diathesis with paradoxical coagulation of blood samples M Harbord, S Ivanova, N Akhtar, Y Gupta 336 Delayed spinal cord compression in ankylosing spondylitis S Harun

No 6 NOVEMBER 1998 Original articles 368 Misuse of the London ambulance service: how much and why? F F Palazzo, 0 Jf Warner, M Harron, A Sadana 371 Foreign body ingestion in children: an audit of transit time D Macgregor, J Ferguson Clinical management 374 Diagnosis and management of transient ischaemic attacks in accident and emergency C Libetta, G S Venables Best evidence topic reports 380 Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary Edited by KMackway-Jones Abstracts 384 Conference on Emergency Medicine, Oxford, 27-30 September 1998 Journal scan 418 Journal scan Edited by J Wardrope, coordinated by J Kitching and C Reid Case reports 421 The calcaneum as a site for intraosseous infusion G McCarthy, P Buss 422 Delayed rupture of the mitral valve complicating blunt chest trauma A D Farmery, P H Chambers, A P Banning 423 Fatal flecainide intoxication E Brazil, G G Bodiwala, D C Bouch 425 A case of streptococcal myositis (misdiagnosed as hamstring injury) N Kang, D Antonopoulos, A Khanna 427 A rare case of hypoglossal nerve palsy complicating a head injury A M Shweikh, S AL- http://emj.bmj.com/ Atrakchi Emergency casebooks 430 Osteomyelitis of calvarium after trivial scalp laceration S A WPickering, R D Ashpole, M E Wallace, S H Paul 431 Supracondylar fracture of the humerus with ipsilateral fracture of the scaphoid in a child M Nashi, B Manjunath, R D Banedee, RJf Creedon 432 Intravesical thermometer: an unusual complication of vaginal temperature measurement on September 29, 2021 by guest. Protected copyright. PJ Riou, A Harris 432 Infected chronic extradural haematoma A R Jf Mitchell, K S El-Shunnar 433 Unusual cause of a raised right hemidiaphragm VInyang Referees 434 Letters to the editor 435 Exsanguinating pelvic fractures A F T Brown; reply S Meek, R Ross 435 Cost of alternative models of care for primary care patients attending accident and emergency departments C VEgleston; reply G Leydon, R Lawrenson, Jf Roberts, R Meakin, G Freeman 435 Primary care problems in patients attending a semi-rural accident and emergency unit Jf Dale, E Glucksman; reply R Cottingham 436 The early management of meningococcal disease G L Campbell-Hewson, S M Robinson 436 Ecstasy related trauma Jf P Davies, R 0 N Evans, D P Newington 437 Recent advances in accident and emergency medicine P S Moss, R Freij 437 A late presentation! A Fraser-Moodie 437 Golf is a dangerous game A C McGuffie, M 0 Fitzpatrick, D Hall 437 Fatal intra-abdominal injury associated with incorrect use of a seat belt L K Dawson, N H_Jenkins Book reviews 438 Acute Paediatrics 438 A Simple Guide to Blood Gas Analysis 438 Notices 439 Index Contents