Injury
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A total of 136 patients required an anaesthetic to enable distal fractures of the forearm to be reduced. There were no significant differences in the numbers requiring remanipulation between the three methods employed: haematoma block, Bier's block or general anaesthesia. The advantages of the haematoma block are discussed.
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The introduction of legislation making the use of seat belts compulsory was associated with a marked reduction in the number of patients coming to the Accident and Emergency Department of a district general hospital as a result of road traffic accidents. Those patients who were not wearing seat belts required hospital admission twice as often as restrained car occupants. ⋯ Rear seat passengers were found to suffer from more severe and more numerous injuries than restrained car occupants. Injuries caused by seat belts were seen, usually causing bruising of the chest wall or minor fractures, and, excluding the chest, those wearing seat belt were less likely to suffer an injury to any part of the body than those not protected by a belt.
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In a prospective study, 85 patients underwent simple observation for minor injuries of the pleural cavity as a result of penetrating injury of the chest. Seven patients (8 per cent) required delayed drainage, because of an increase in the size of the pneumothorax and/or haemothorax, but in all cases drainage was instituted within 24 hours. ⋯ Subcutaneous emphysema is of no value for identifying those cases likely to need delayed drainage. Twenty-four hours is adequate for the observation of patients with slight effects of penetrating wounds of the chest.
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Peritoneal lavage is a sensitive method of detecting intra-abdominal injuries following closed abdominal injury. Our indications for peritoneal lavage are: severe head injury, severe thoracic injury, unexplained hypotension in a patient with possible blunt abdominal injury and patients on artificial ventilation. ⋯ Eighteen lavages were negative; no laparotomy was performed in this group. There was one false positive, but no false negative lavage.