Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jan 1995
The trauma team concept and its implementation in a district general hospital.
A trauma team approach to the initial assessment, investigation and treatment of potentially seriously injured patients has been implemented at a district general hospital. Team members are mobilised by an emergency paging system which is activated when a patient fulfils one or more of a predetermined list of historical, pathophysiological and anatomical criteria. Aspects of the function of the trauma team were assessed after 10 months of operation. ⋯ Although hospitals differ in workload and staffing, the trauma team concept is possible and achievable at no extra cost. Trauma teams maximise existing resources and constitute a valid approach to the early management of the irregular presentation of the severely injured patient to district general hospitals. The establishment of such teams with members who should be ATLS trained, should be a current priority in district general hospitals in the UK.
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Ann R Coll Surg Engl · Jan 1995
Randomized Controlled Trial Clinical TrialIs there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?
The benefits of parenteral non-steroidal analgesic drugs and low molecular weight heparin anticoagulants have been shown before, but there is concern that the use of these agents in combination may potentiate haemorrhagic side-effects because of simultaneous inhibition of the clotting cascade and platelet mechanisms of haemostasis. In a prospective controlled trial, 60 patients undergoing total hip replacement were randomised into two groups. Those in one group received intramuscular ketorolac and those in the other group opioid analgesia. ⋯ There were 34 patients in the NSAID group and 26 in the opiate group. There were no significant differences between the two groups for intraoperative blood loss, postoperative drainage, transfusion requirements, bruising, wound oozing and leg swelling. From this study it would appear that there is a low risk of significant haemostatic potentiation associated with concurrent use of low molecular weight heparin and a modest dose of ketorolac tromethamine.
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Ann R Coll Surg Engl · Jan 1995
Bicyclist head injury prevention by helmets and mandatory wearing legislation in Victoria, Australia.
After a decade of promotion and education, legislation for mandatory helmet wearing by bicyclists in Victoria was introduced on 1 July 1990. The legislation was a world first. ⋯ Legislation for mandatory helmet wearing in Victoria has led to increased wearing rates and marked reductions in bicyclist fatalities and head injuries. The Victorian experience gives substantial support to the introduction of legislation for mandatory helmet wearing by bicyclists.
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Ann R Coll Surg Engl · Jan 1995
Neurological complications of high tibial osteotomy--the fibular osteotomy as a causative factor: a clinical and anatomical study.
A clinical study of 105 upper tibial osteotomies was undertaken to investigate the incidence, pathology and outcome of perioperative neurological deficit. Motor weakness and/or sensory deficit occurred in 21 patients (20%) and in half of these the deficit was permanent. ⋯ An anatomical explanation is proposed for this complication, based on cadaveric studies. Due to unacceptably high levels of complications it is recommended that the fibular osteotomy should not be performed in zones II and III (from just below the fibular head to 15 cm distal to this level).