Injury
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Peritoneal lavage is a sensitive method of detecting intra-abdominal injuries following closed abdominal injury. Our indications for peritoneal lavage are: severe head injury, severe thoracic injury, unexplained hypotension in a patient with possible blunt abdominal injury and patients on artificial ventilation. ⋯ Eighteen lavages were negative; no laparotomy was performed in this group. There was one false positive, but no false negative lavage.
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In a prospective study, 85 patients underwent simple observation for minor injuries of the pleural cavity as a result of penetrating injury of the chest. Seven patients (8 per cent) required delayed drainage, because of an increase in the size of the pneumothorax and/or haemothorax, but in all cases drainage was instituted within 24 hours. ⋯ Subcutaneous emphysema is of no value for identifying those cases likely to need delayed drainage. Twenty-four hours is adequate for the observation of patients with slight effects of penetrating wounds of the chest.
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The resuscitation of the severely injured in the accident and emergency department--a medical audit.
An audit of the medical care of the severely injured was conducted in the Accident and Emergency Department of the Royal Victoria Hospital, Belfast. Over a 6-month period the management of all patients admitted with an Injury Severity Score of 16 or over was critically assessed. ⋯ They were mainly related to the fact that 78 per cent of the patients arrived outside normal office hours when only inexperienced junior doctors staffed the department. The findings have drawn our attention to the need for both altering staffing arrangements and improving training in our department.
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One hundred and sixteen cases of ankle fractures were classified by the AO system and treated by open reduction and internal fixation in accordance with the AO principles. The stabilization of the lateral malleolus was emphasized. Ninety-six cases were available for functional assessment with an average follow-up of 39 months. ⋯ There was no death or non-union. Local complications included wound infection (8.6 per cent) and skin necrosis (3 per cent). This study illustrates the importance of exact anatomical reduction and stable internal fixation to allow early movement after an intra-articular fracture of the ankle.