Injury
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The purpose of this study was to introduce the principles of initial hospital assessment and treatment of injured patients, tailored to the facilities and resources available in Nigeria. A 3-day didactic and laboratory course was presented by four trauma surgeons. The didactic session stressed the initial assessment and treatment of injured patients. ⋯ The mean pre-course test score was 49.3 per cent and the mean post-course test score was 69.5 per cent; 93.5 per cent of the 124 participants increased their test scores. This represents a significant increase in knowledge in Nigerian physicians. Academic medical centres are encouraged to make such courses available in developing countries.
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Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). ⋯ As a 3 cm cannula would fail to reach the pleural cavity in over half of patients, we suggest that the recommended shortest length be increased to 4.5 cm. Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
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An X-ray-based image intensification system is a necessary operative aid in many orthopaedic procedures. Technological advances have not only increased the resolution of these systems, but allow the production of thermal images. We have compared such images obtained at the time of surgery with postoperative radiographs in 80 patients who underwent closed reduction and internal fixation for proximal femoral fractures. ⋯ We therefore suggest that a postoperative radiograph is only necessary in exceptional circumstances. This is of significance in relation to patient discomfort, morbidity and radiation exposure. It also has important financial and manpower implications.
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In this study, we have evaluated the performance of the Revised Trauma Score (RTS) as a triage instrument in the prehospital setting in The Netherlands. To this end we analysed prehospital and clinical data on 398 injured patients in an urban-rural area in the east of the Netherlands. Our study included injured patients aged over 15 who were alive at the time the ambulance arrived. ⋯ The specificity and the predictive value of a lowered RTS, however, were 94 per cent and 26 per cent respectively for all definitions used. The conclusion of this study is that the performance of the RTS in this study population is poorer than expected from earlier studies. The low prevalence of major injuries in the prehospital setting in The Netherlands and the distribution of case severity may possibly explain these results.