Injury
-
The observations of pallor, sweating, agitation and restlessness, at the time of an injured patient's admission to the resuscitation room, were compared with other more complex indices of injury severity and the ability of each observation to predict mortality was observed. The number of positive observations was significantly related to the Revised Trauma Score and the Injury Severity Score, and pallor was significantly related to mortality. The observation that an injured patient is pale is an important index of severity.
-
Comparative Study
Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation.
This study assesses the rigidity and strength of fixation provided by intramedullary and extramedullary devices for proximal femoral fractures. Stable and unstable intertrochanteric fractures were studied in paired femora after internal fixation with the Gamma nail and Richards 135 degrees classic hip-screw implants; in subtrochanteric fractures, the 95 degrees Richards condylar screw was studied in addition. ⋯ Under conditions of simulated protected weight bearing, the 95 degrees condylar screw plate provided more rigid fixation than did the 135 degrees hip screw. There was no significant difference in the strength of fixation of stable and unstable intertrochanteric fractures between the Gamma nail and the hip screw, although the Gamma nail provided more rigid fixation.
-
Major thoracic injuries are uncommon in the United Kingdom and wide experience of their management by centres in this country has not been reported. Between 1985 and 1990, 23 patients have undergone urgent thoracotomy at Birmingham Accident Hospital for suspected intrathoracic injury. The majority of these injuries were caused by penetrating trauma (13 patients). ⋯ Two patients who died after a blunt injury had a less than 50 per cent probability of death by the TRISS method although one of these patients died from postoperative complications. This series illustrates the point that prompt recognition of a suspected intrathoracic injury and appropriate urgent surgical intervention to relieve cardiac tamponade and control intrathoracic haemorrhage in these patients can produce a successful outcome. In addition it it is essential that all units audit their own results in order to highlight areas where improvements in trauma care can be made.
-
Three cases of successful resuscitation after attempted suicide by hanging are described. Although all came in with profound unconsciousness, they made a full recovery with no residual dysfunction after resuscitation by intubation and ventilation for 12 h. Steroids and mannitol were not used. All patients were referred for psychiatric consultation before discharge from hospital.