European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Accidental firearm injury in childhood--a predictor of social and medical outcome?
This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. ⋯ Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.
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Mechanical airway obstruction secondary to retropharyngeal haematoma is a life-threatening emergency and should be anticipated in all cervical spine injure patients regardless of the severity of trauma. Most retropharyngeal haematomas described in the literature have involved complicating factors such as anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. ⋯ He sustained an atlanto-occipital fracture-dislocation and a very large retropharyngeal haematoma which resulted in airway obstruction and a subsequent difficult intubation. We outline the normal anatomy of the retropharyngeal space, the pathogenesis of retropharyngeal haematomas, and outline techniques of intubation available.
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Comparative Study
Safety and efficacy of diagnostic peritoneal lavage performed by supervised surgical and emergency medicine residents.
Diagnostic peritoneal lavage (DPL) remains an accurate diagnostic test for intra-abdominal injury. This study examined the safety and efficacy of DPL performed by supervised residents in an urban trauma centre. A retrospective chart review was carried out of a one year experience (July 1994-June 1995). ⋯ Thirty-four patients (6.6%) died, none from the DPL. DPL obviated the need for computed tomography scan of the abdomen and/or pelvis in 464 patients resulting in a cost saving of approximately $250,000. DPL performed by supervised junior surgical and senior emergency medicine residents is a safe and cost-effective method of evaluating patients with potential intra-abdominal injury.
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Paramedic training and skills have been introduced in the United Kingdom in an attempt to improve prehospital patient care. There is presently little control and quality assurance in this potentially difficult environment and paramedic protocols have not been validated. We studied the use of nalbuphine by paramedics for patients with major injury in West Yorkshire. ⋯ The panel also concluded that 21 (18%) of the 115 patient control group could have been administered nalbuphine but did not receive the drug. This study demonstrates inadequate and sometimes inappropriate use of nalbuphine in prehospital trauma care. Quality assurance and audit systems should be implemented to identify and correct these deficiencies.
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Escherichia coli O157 infection disaster occurred in Sakai in the summer of 1996, in which over 6000 infections and three deaths occurred. Seventeen patients, including four girls with haemolytic uraemic syndrome, were treated successfully in our hospital and information was published, as quickly as possible, on our internet home page.