Injury
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The criteria for ordering abdominal CT scans in the secondary survey of stable bluntly injured patients was examined. A patient population at high risk for having intra-abdominal injury (IAI) was identified by physical examination, a fall in haematocrit, and haematuria. A total of 444 patients receiving abdominal CT scans at a large urban trauma centre were reviewed. ⋯ The benefit of a CT scan for patients without abdominal tenderness or with an isolated fall in haematocrit is questionable. Serial abdominal examinations should remain the most timely and cost-effective method for identifying IAI in stable patients. The specificity and NPV of abdominal tenderness combined with haematuria approaches that of CT.
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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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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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A consecutive series of 103 patients with a subtrochanteric fracture were prospectively studied. Ten patients were treated non-operatively, whilst the other 93 had operative treatment. ⋯ No method of fracture classification was demonstrated to be of value in predicting either the choice of treatment or the risk of fracture healing complications. Either intramedullary nailing or extramedullary fixation with a dynamic hip screw appear to give the best results for subtrochanteric fractures.