Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Lack of efficacy of 'weighted' radiographs in diagnosing acute acromioclavicular separation.
The efficacy of "weighted" films in diagnosing grade 3 acromioclavicular (AC) sprains not evident on plain (unweighted) films was evaluated. Eighty-three pairs of radiographs, taken with and without weights, of patients with suspected AC injury were studied. The films were read in a randomized and blinded manner by a staff radiologist. ⋯ In only three cases (4%) did weights cause the injured CC distance to increase and thereby unmask a grade 3 injury not evident on plain films. Further evidence that weights may not reliably elucidate the degree of AC joint injury is suggested by the fact that in several cases the weights actually caused the injured and uninjured CC distance to decrease. We conclude that the use of weighted radiographs lacks efficacy in unmasking grade 3 AC sprains on radiograph and we recommend that routine use of this technique be abandoned.
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Axial (in-line) traction is recommended as a stabilizing maneuver during orotracheal intubation of a trauma victim with a potential cervical spine injury. There are no published data demonstrating the safety of this technique in trauma patients with an unstable cervical spine. In our study, 17 victims of blunt traumatic arrest had radiographic analysis of the cervical spine during orotracheal intubation, with and without axial traction. ⋯ This depends on the direction of the traction force and integrity of surrounding tissues. We recommend that trauma patients requiring intubation prior to a complete examination and radiographic analysis of the cervical spine be nasotracheally intubated without axial traction, and that the head and neck be stabilized in the neutral position. If a contraindication to nasotracheal intubation exists, a cricothyroidotomy should be performed.
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We report the case of a 27-year-old man with bilateral chylothorax. The patient presented with shortness of breath and bilateral pleural effusions three days after a motor vehicle accident. ⋯ Bilateral chylothorax secondary to blunt trauma has rarely been reported. The etiology, pathogenesis, clinical presentation, and recommended therapy are reviewed.