Neuralgic amyotrophy presenting to an accident and emergency department.

Two patients with neuralgic amyotrophy (Parsonage-Turner syndrome) are described. Problems arising from the shoulder girdle commonly present to accident and emergency (A&E) departments. Neuralgic amyotrophy is an infrequent neuromuscular disorder which predominantly affects the shoulder girdle. Characterised by severe pain followed by muscle weakness, atrophy, and variable sensory deficits, the diagnosis is based on history and physical findings and is confirmed by electromyography. The prognosis is excellent and treatment is supportive using analgesia and physiotherapy.

Doppler measurement of cardiac output during cardiopulmonary resuscitation.

OBJECTIVE: To estimate the cardiac output produced by external cardiac compression during standard cardiopulmonary resuscitation performed by two groups of operators with different levels of experience and training. METHODS: Cardiac output was measured by Doppler aortovelography. All patients included in the study had necropsy examinations. Only patients without evidence of pulmonary embolism, myocardial rupture, aortic valve disease, or acute depletion of the intravascular volume were included. RESULTS: 31 patients presenting to the accident and emergency department suffering from non-traumatic cardiac arrest had cardiac output measurements made during resuscitation. Eleven patients were excluded after necropsy examination. The median cardiac index for the 20 study patients was 3.2 L min-1 m-2. The cardiac output produced by massage by less experienced personnel (median 1.2 L min-1 m-2) was significantly less than that produced by those fully trained in the technique (median 3.2 L min-1 m-2; P < 0.01 95% confidence interval -2.36 to -1.29). The amount of resuscitation related trauma was no greater than in other published series. CONCLUSIONS: Differences in cardiac output during external cardiac compression are related to experience with the technique.

A study of wrist injuries in children: the incidence of various injuries and of premature closure of the distal radial growth plate.

There were 362 wrist injuries in 359 patients under 18 years of age who attended the Accident & Emergency Department, St James's University Hospital, Leeds, over a 1-year period. These included soft tissue injuries (53%), epiphyseal injuries (4%) and fractures of the distal forearm or carpus (43%) which were reviewed 3 years after injury. At re-examination, a repeat X-ray was undertaken and this showed evidence of premature epiphyseal fusion in three of the 281 who returned for review and in these three patients there was a history of persistent symptoms in the affected wrist or forearm. It is suggested that patients with an obvious epiphyseal injury or those who have persistent symptoms following an injury to the wrist should be followed carefully to skeletal maturity in order to detect early partial or total closure of the growth plate.

Beware the patient with a headache in the accident and emergency department.

We have reviewed the 130 patients presenting to an accident and emergency (A & E) department with a headache, followed up for 2 years. These are infrequent attenders but we have found that there is a high incidence of serious neurological pathology (16%) in this group of patients. We suggest that patients presenting to the A & E department with headache should be thoroughly examined and investigated and in the absence of a definite benign diagnosis should at least be admitted for a period of observation.