Injury
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Over a two and a half year period, 25 patients presenting to the Glasgow Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A&E) department and seven (28 per cent) in a fully equipped operating theatre after resuscitation. There were 23 men and 2 women. ⋯ Outcomes may be improved if appropriately trained hospital staff are immediately available and prehospital delays are minimized so that patients arrive sooner with signs of life still present. Ambulance paramedic interventions have little to offer these patients and may worsen the prognosis if they result in delayed transport to hospital. The emphasis placed on diagnosis and treatment of cardiac tamponade in Advanced Trauma Life Support programmes is appropriate and all staff involved in these cases should undergo this type of training.
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The diagnosis of blunt abdominal injuries is one of the most difficult problems in the management of trauma. There is now better understanding of the diagnostic facilities available. Guidelines regarding the use of diagnostic peritoneal lavage, ultrasonography, or computed tomography scanning should be available in the Accident and Emergency department.
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Horse riding is a dangerous pastime with more accidents occurring per hour than during motor-cycling. Since a prospective survey of horse-related injuries conducted at a major centre in 1971-1972, equestrian groups and the medical profession have encouraged improvements in training and protective riding wear. By conducting a similar study at the same centre 20 years later we hoped to assess the effects of these measures on the pattern of injuries resulting from contact with horses. ⋯ In seven cases, severe digital injuries were caused by the habit of entwining reins around the fingers. This practice should be discouraged. Up to 12 per cent of all injuries might have been prevented if adequate footwear had been worn.
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'Joy-riding' is the term used, somewhat inappropriately, for the offence of taking a vehicle without the owner's consent. In certain areas, mainly deprived inner-city estates, there has been an increase in this crime. The aim of this study was to investigate its impact on the workload of an inner-city teaching hospital's busy accident and orthopaedic departments. ⋯ Three patients (one joy-rider and two innocent bystanders) died as a result of car crime. The average length of hospital stay was 12 days (1-62 days) and the hospital in-patient costs were estimated to be at least 5200 pounds per patient. Injuries related to car crime results in a significant amount of work and financial cost to the National Health Service.
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Comparative Study
Does the dangerous dogs act protect against animal attacks: a prospective study of mammalian bites in the accident and emergency department.
This comparative prospective study of mammalian bites attending one urban Accident and Emergency department before the implementation of the Dangerous Dogs Act 1991 and again 2 years later, was to see the effect of the Act on the pattern of injury. The study comprised a simple questionnaire detailing the injury, the implicated species, and the treatment or referral if applicable. In both groups studied (before and after implementation of the Act) 134 consecutive bites were recorded, contributing 1.2 per cent and 1.23 per cent of total attendances during these respective periods. ⋯ This study also shows how dangerous breeds compare with others that bite, demonstrating that these breeds contribute to only a small proportion of these injuries. This comparative study clearly demonstrates little impact on rate of attendances for such injuries since the introduction of the 1991 Act. If legislation aims to reduce and prevent injury from animal bites, in its present form it does little to protect the public; this study suggests a wider control of the dog population may be required.