Injury
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To determine the incidence of carpal instability and its relation to clinical findings in patients with suspected scaphoid fracture, we performed a long-term follow-up investigation in a consecutive series of 160 patients who were treated in our department of traumatology for suspected scaphoid fracture after a fall on the outstretched hand. Radiography of the carpus was obtained. Bone scintigraphy was performed in all patients with negative initial radiographs. ⋯ The incidence of complaints and a positive synovia test were significantly higher in patients with suspected carpal instability. The bone scan was not useful for the detection or exclusion of carpal instability. The three-phase bone scan gave no additional information in the diagnosis of carpal instability.
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Advanced Trauma Life Support requires surgical airway techniques to be used in patients when oral or nasal intubation is impossible or contraindicated. Few reports have examined the results of surgical cricothyroidotomy in prehospital trauma management. During a 12-month period, 600 patients were seen and treated by the Helicopter Emergency Medical Service medical team. ⋯ Three patient later died in hospital and four (37 per cent) survived. Three of the survivors made a good recovery, including one who was in cardiorespiratory arrest at the scene, and one remains severely disabled. Surgical cricothyroidotomy is a life-saving procedure in prehospital trauma management that must be performed without delay or hesitation if conventional airway manoeuvres are impossible or fail.