Injury
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of intra-articular lignocaine and a suprascapular nerve block for acute anterior shoulder dislocation.
We compared the analgesic effects of a suprascapular nerve block with intra-articular local anaesthetic in 20 patients presenting with acute anterior glenohumeral dislocations. The intra-articular local anaesthetic technique was a simpler procedure which provided significantly more analgesia for patients.
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Comparative Study
Trauma triage: a comparison of CRAMS and TRTS in a UK population.
The CRAMS scale and the Triage Revised Trauma Score (TRTS) were compared to assess their potential use as a prehospital method of activating hospital trauma teams. We studied patients from the resuscitation room of Leeds General Infirmary who had enough data recorded to allow calculation of the admission TRTS and CRAMS scale. Patients were defined as having major injury if they died in hospital, were admitted to the ICU or had an Injury Severity Score (ISS) of > 15. ⋯ The TRTS was significantly more specific (0.9 versus 0.75) but at a cost of poor sensitivity (0.6 versus 0.69, not significant). The performance of both scales was similar when compared on the ROC curve. CRAMS and the TRTS were unable to identify major injuries in our sample with sensitivity and specificity adequate to support their use as a tool to activate trauma teams in the UK.
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The use of airguns in attempted suicide is uncommon. In such instances, the surface wounds caused by discharged pellets may be inconspicuous or appear deceptively trivial to the medical examiner. Airgun pellets however are easily capable of penetrating the skull or abdominal cavity when fired at the close ranges involved in suicide attempts. ⋯ Most of the victims were male. The majority of wounds were right sided. Four of the attempts were extremely determined, involving repeated discharge of the airgun or the use of other means to effect suicide.
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To determine the existence and composition of Trauma Teams in UK hospitals postal and telephone enquiries were made to 185 Accident & Emergency (A&E) departments comprising all those in the UK with an annual attendance of over 30,000 patients per year. The existence of Trauma Teams was not influenced by the number of A&E attendances or the medical staffing composition in the A&E department. ⋯ In 58 out of the 69 hospitals the difficulties in getting the appropriate doctors to respond quickly to multiply injured patients was the main reason for not making any arrangements for rapid multidisciplinary evaluation of them. Changing the medical profession's attitude to injury management is a hurdle that will need to be overcome.