--- Danny McGeehan <[log in to unmask]> wrote:
> I'm sorry to have been quiet these last few days but
> have been in London on the above awaydays. I
> thought I would share my feelings with the list.
Danny we love it when you share your feelings with the
list but you often leave us hanging on (isnt that
another diana ross song?).. Tell us what you think
...a bit like a version of the truth game, you tell
me what you think and then I'll do like wise.....
Why exactly is there no future for 'A&E in the UK'??
Will Rowley tell us that was written by the sex
pistols?
Steve
> I came away feeling very concerned as I honestly can
> see no future for A & E in the UK.
> It is all going to be taken away and one won't even
> be left with the minor injuries. I thought the lead
> was very patronising in my own opinion have met her
> in previous existence when was nurse manager and
> before that F-grade. Not a patch on Doreen Rothman
> who had a similar position in the DoH and was a
> great support to the speciality and made a great
> point of going around and meeting people and knowing
> what was going on.
>
> Did not take kindly to being reminded that we were
> as privileged I presume as those who were at
> Agincourt or the Somme and that we would be telling
> our Grandchildren about it, in the opening address.
>
> The cost must have been collosal and in my opinion
> scadulous. My accomodation in London was only £15 a
> night as I would not stay in the hotel which was
> £220 a night.
> Heard on reliable info that bill ran into couple of
> hundred thousand. When you consider that patients
> are lying around on trolleys all night in the modern
> NHS I was felt very disturbed and consider the
> number of staff one can employ for that.
>
> I think the only thing I did learn is that for
> modernisation equate cuts and I certainly feel an
> empathy with the firefighters after it. After the
> couple of days that I spent there I certainly would
> not be recommending A & E as a career in the UK.
> Lots of other thoughts and if any interest I will
> chip in with a few more comments.
>
> Needless to say I don't think or I certainly cannot
> recollect one A&E Specialist actually giving a talk
> in the main conference. I know Adrian and Matthew
> actually chaired a discussion session. However we
> did not figure highly. I can honestly see the
> speciality being squeezed even more and it doesn't
> look good I'm afraid to say.
>
> Danny McGeehan
>
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<DIV>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial size=2>I found
another study demonstrating the effectiveness of
intranasal midazolam for the
treatment of convulsions. See below.</FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial size=2>Having
mentioned the use of atomizers I thought I'd better
emphasise that the
bioavailability is enhanced to 80% plus compared to
the use of intranasal drops
at 50%. But I think there is a wide safety margin in
the dose, based on the two
papers we did at Lancaster using midazolam for
sedation.</FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial size=2>Ray
McGlone</FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial size=2>A&E
Lancaster</FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm
0pt"><B>Title</B> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt
36pt">Effects of <B>intranasal</B>
<B>midazolam</B> and rectal diazepam on acute
convulsions in children:
prospective randomized study.</P>
<P class=MsoNormal style="MARGIN: 0cm 0cm
0pt"><B>Source</B> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt
36pt">Journal of Child Neurology.
17(2):123-6, 2002 Feb.</P>
<P class=MsoNormal style="MARGIN: 0cm 0cm
0pt"><B>Abstract</B> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt 36pt">In
this study, the effects
and side effects of rectal diazepam and
<B>intranasal</B> <B>midazolam</B> were
compared in the treatment of acute convulsions in
children to develop a
practical and safe treatment protocol. In the diazepam
group, the seizures of 13
(60%) patients terminated in 10 minutes; however, 9
(40%) patients did not
respond. In the <B>midazolam</B> group, 20 (87%)
patients responded in 10
minutes, but 3 (13%) patients did not respond.
Regarding the anticonvulsant
effect, <B>midazolam</B> was found to be more
effective than diazepam, and the
difference was statistically significant (P < .05).
The necessity of a second
drug for the seizures that did not stop with the first
drug was higher in the
diazepam group than the <B>midazolam</B> group, and
the difference was
statistically significant (P < .05). We conclude
that as an antiepileptic
agent, <B>intranasal</B> <B>midazolam</B> is more
effective than rectal
diazepam. After <B>administration,</B> we did not
observe any serious
complications. Further investigations are necessary;
however, <B>intranasal</B>
administration is easy, so if the nasal drop and spray
forms used in some
European countries and the <?xml:namespace prefix =
st1 ns =
"urn:schemas-microsoft-com:office:smarttags"
/><st1:country-region><st1:place>United
States</st1:place></st1:country-region>
are available worldwide, it will be very useful for
physicians in the emergency
room.</P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt
36pt"> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt
36pt"><FONT face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt
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size=2></FONT> </P></DIV>
<BLOCKQUOTE dir=ltr
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px;
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<DIV style="FONT: 10pt arial">----- Original Message
----- </DIV>
<DIV
style="BACKGROUND: #e4e4e4; FONT: 10pt arial;
font-color: black"><B>From:</B>
<A [log in to unmask]
href="mailto:[log in to unmask]">Ray
McGlone</A> </DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A
[log in to unmask]
href="mailto:[log in to unmask]">[log in to unmask]</A>
</DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Saturday,
November 02, 2002 6:16
PM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> Intra
nasal midazolam for
fits</DIV>
<DIV><BR></DIV>
<DIV><FONT face=Arial size=2><A
href="http://www.wolfetory.com/mad100400order.html">http://www.wolfetory.com/mad100400order.html</A></FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>Had a 16 mth child into
today who had been
fitting continously since the 999 call. Rectal
diazepam given by the
paramedics had no effect. It was a stand by call so
all the paediatric
team (including senior and SpR) were
there.</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=Arial size=2>I'd given intranasal
midazolam and the fits had
stopped whilst the team had still not managed
to get iv
access.</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=Arial size=2>The above web site is a
firm making atomizers for
drugs. The atomizer simply fits onto the syringe. My
colleague Stuart Durham
found out about them and they certainly work. The
site also has an atomizer in
the shape of a fish, but I think that is a bit
OTT.</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=Arial size=2>It's a shame paramedics
don't have access to this
route particularly in rural areas like
mine.</FONT> <FONT face=Arial
size=2>In case anyone from JRCALC is reading
this?????</FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV> </DIV>
<DIV><FONT face=Arial size=2>Ray
McGlone</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=Arial size=2>A&E
Consultant<BR><BR>Morecambe Bay Hospitals
NHS Trust<BR><A
href="http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm">http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm</A></FONT></DIV></BLOCKQUOTE></BODY></HTML>
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