Departments should seek to monitor individuals responsible for episodes of violence and aggression in order to detect repeat offenders. A prospective study comprising post-incident reviews may provide a valuable insight into the causes of violence and aggression.

SUMMARYThe aim of this prospective trial was to compare the efficacy of gastric lavage, activated charcoal and ipecacuanha at limiting the absorption of paracetamol in overdose and to assess the significance of the continued absorption of paracetamol following treatment. Patients aged 16 and over who had ingested 5 gms or more of paracetamol within 4 h of admission were entered into the trial. The percentage fall in plasma paracetamol level was used as the measure of the success of a treatment at limiting absorption. The mean percentage fall was 39-3 for gastric lavage, 52-2 for activated charcoal and 40.7 for ipecacuanha, with a significant difference between the treatment methods (p = 0.03). Activated charcoal was more effective at limiting the absorption of paracetamol following overdose than either gastric lavage or ipecacuanha induced emesis. In treated patients continuing paracetamol absorption is not significant if more than 2 h have elapsed since ingestion.

A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.

During two months in the winter and two in the summer information was gleaned about all patients aged 70 and over attending a large accident and emergency department. Comparative figures for the same periods over the previous 20 years showed an increasing number of elderly attendees, the increase being closely related to the increasing proportion of elderly in the population. Using national census data, attendance rates were shown to increase dramatically with age. With increasing age more elderly attended as a result of accidents in the home. The information suggested that social isolation and paucity of support in the community may be responsible for the decision to come to hospital rather than to consult the general practitioner.The elderly attend accident and emergency departments for a wide range of problems but some do so solely for socioeconomic reasons and are particularly difficult to help.

Summary Plasma electrolytes, glucose and insulin concentrations were measured and serial electrocardiograms performed during the intravenous infusion of salbutamol to five women in premature labour. The plasma potassium (mean±standard error) fell from 3·5±0·l to 2·7±0·l mmol/l, and the glucose and insulin rose by 4·2±0·7 mmol/l (72·13 mg/100 ml) and 26·5 mU/l respectively. The maximum fall in potassium, and the rise in glucose and insulin occurred two hours after starting the infusion. No changes in other electrolytes were found. Electrocardiograms showed no signs of hypokalaemia. Highest pulse rates (148·4 beats per minute) occurred at two hours but no arrhythmias were observed.

A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.

Objective-To examine current patterns of deployment and use of emergency ambulance crews in Nottinghamshire, with particular reference to crew status (technician or paramedic), case mix, interventions performed, and operational times. Methods-A retrospective survey of routinely collected computerised ambulance service despatch data, and patient treatment forms for 242 randomly selected emergency callouts in Nottinghamshire, during September 1994. Data were collected on patient demography, broad diagnostic group, crew status and operational times, and paramedic interventions performed. Results-170 of 242 callouts (70%) involved a paramedic crew; extended skills were used on 31 of these occasions (18%), predominantly for medical emergencies. Paramedic crews recorded significantly longer on-scene times (median time: 14.0 v 11.5 min, P = 0.04). An examination of the difference between paramedics who performed interventions and those who did not revealed that "intervening" paramedics recorded significantly longer onscene times (median time: 23 v 12 min, P<0.001), turnaround times (median time: 28 v 18 min, P<0.001), and total outof-service times (median time 73 v 51 min, P<0.001). Conclusions-The additional time taken by paramedics at the scene of an emergency incident relates to their performance of an intervention, rather than time spent assessing the patient to decide whether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergencies. The performance of paramedic interventions also extended turnaround times and total out-of-service times. (JAccid Emerg Med 1996;13:383-385)

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