Injury
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Forty-five trauma cases underwent emergency room thoracotomy (ERT) for circulatory collapse or cardiac arrest in the resuscitation area. There were no survivors in the blunt injury group (13 cases). ⋯ Although ERT gives good results only for cardiac tamponade, not all cases of tamponade are clinically obvious on admission. The authors recommend that ERT be done on all cases of collapse or arrest following penetrating chest injury where signs of life have been present within the previous 3 min.
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Case Reports
Dislocation of the elbow joint associated with fracture of the radial neck in children.
We describe two cases of fracture of the radial neck associated with posterolateral dislocation of the elbow. The purpose of this report is to describe the relatively good functional result that can be achieved by a successful closed reduction of this severe injury.
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We evaluated the Revised Trauma Score (RTS) for the rapid identification of severely injured patients on their arrival at the accident and emergency department. A total of 1407 consecutively injured patients admitted to the Accident and Emergency Department of the Royal Victoria Hospital, Belfast, had their RTSs calculated on arrival. A trauma team, consisting of experienced senior doctors, was summoned for all patients with an abnormal RTS of 11 or less. ⋯ Second, systolic hypotension following trauma is an important sign of serious injury. We recommend the use of the RTS as an aid to junior doctors in the recognition of seriously injured patients in the accident and emergency department. Furthermore, the score should be recalculated at frequent intervals while the patient remains in the department.
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Helicopters have been used for the evaluation of civilian casualties since the 1960s. This trend has been increasing and a number of helicopter emergency services have now commenced in the UK. Despite these developments, little attention has been paid to their exact role, and the potential benefits to patients. ⋯ Similar or improved results may be obtained through the use of more cost-effective ground-based units. Judicious placement of both helicopter emergency services and land-based 'flying squads' in an integrated accident service may contribute usefully to better care of patients. However, enthusiasm for helicopters should not lead to a waste of resources and should be accompanied by careful consideration, planning and audit of their use.