A survey of the management of transient loss of consciousness in the emergency department.

UNLABELLED: Transient loss of consciousness (TLoC) is a common presentation to the emergency department (ED). We sought to evaluate current practice in the management of patients with TLoC presenting to a large, city centre ED, against national standards. METHODS: The ED admissions database was searched to identify all patients attending with TLoC during October 2012. The clinical record of the attendance was reviewed to determine if the initial assessment met national standards. RESULTS: Ninety-one patients had a primary presentation with TLoC, representing 0.95% of ED attendances. Documentation of before/during/after the clinical event and clinical examination were done well. Notable aspects done less well included lying and standing blood pressure and recording of driving status. No patient was discharged from the ED with a copy of their 12-lead electrocardiogram (ECG). Sixty-five patients (71%) were discharged from the ED, with follow-up arranged for 11 (16%). Additional follow-up would have been appropriate in a further 15 cases (28%). CONCLUSION: Several aspects of the initial assessment of TLoC were done well. Areas for improvement include driving status documentation and advice, recording of postural blood pressures and ECG provision on discharge.

Bacterial study of clean intermittent catheterisation in children.

Deterioration of the upper urinary tract is exceptional in children on clean intermittent catheterisation for neuropathic incontinence and is found only in those with pre-existing renal damage. This report describes a bacteriological study of 24 children, of whom 10 had renal damage and 14 did not have renal damage before clean intermittent catheterisation began. Boric acid was added as a preservative to samples of urine in preference to the use of dip-slides because it preserves pus cells as well as bacteria. The incidence of bacteriuria in the two groups was similar (78% of samples from those with, and 72% of samples from those without, pre-existing renal damage). The groups differed in that the urine of children in the group with pre-existing renal damage yielded organisms other than Escherichia coli more than twice as often as did the urine of those children without renal damage. Moreover, the children with pre-existing renal damage were more likely to have fever with urinary tract infection and some of them showed frequent changes of organisms in the urine. Whatever organism was present, however, children in the group with renal damage more often had heavy pyuria.