International journal of clinical practice
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Int. J. Clin. Pract. · Jan 2002
Use of a customised endotracheal tube for tracheostomy in the large neck.
Patients with huge necks who require a tracheostomy pose particular problems. This paper describes a technique to customise a standard endotracheal tube to make a long tracheostomy tube. This can be used as a short-term emergency airway. It is recommended because it is cheap, simple, safe and potentially life saving.
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A foreign body causing obstruction of the larynx is usually removed by coughing, blows to the back, chest thrusts, abdominal compression or finger sweep manoeuvres on the unconscious victim. In extremis, crichothyroidotomy or emergency tracheostomy may be the only life-saving option. ⋯ A case of supraglottic impaction of the larynx by a piece of sausage occurred in our hospital; the patient was semiconscious. It was managed successfully by a carefully timed laryngoscope blade being inserted into the mouth without the aid of sedative drugs.
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This report describes a complex syndrome of injuries occurring in a young female who was a back seat passenger wearing a lap-belt restraint in a high-speed road traffic accident. As a consequence of the forced flexion distraction injury of her lumbar spine, she sustained a fracture-subluxation of the first lumbar vertebra in association with a jejunal perforation and extensive small intestinal mesenteric laceration. She also had a large traumatic hernia of the anterior abdominal wall, which was overlooked at primary laparotomy. This report highlights collectively the classical combination of injuries associated with the lap-belt syndrome and demonstrates the importance of carefully inspecting the anterior abdominal wall for deficiencies, because traumatic herniation may be easily overlooked.
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Int. J. Clin. Pract. · Sep 2001
Case ReportsThalamic tumour presenting as frontal lobe dysfunction.
A 64-year-old man presented with a change in personality and behaviour but with no neurological deficits. He exhibited impaired executive functions, apathy, unsteadiness of gait and falling; he lacked insight and exhibited purposeless behaviour, making loud grunting noises. A CT scan at 6 months revealed no abnormality, but at 9 months CT and MRI showed a bilateral thalamic tumour. The presenting symptoms had similarities to frontal lobe dysfunction progressing to dementia.
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Int. J. Clin. Pract. · Jul 2001
ReviewSmoking cessation: a consensus statement with special reference to primary care.
Nicotine addiction is a serious medical condition that needs to be treated like any other chronic disease. Primary care must play a key role in smoking cessation and offering help should be a routine part of primary care practice. As the most frequent opportunity for intervention lies within primary care, GPs should ensure that they raise the issue of stopping smoking at least annually with their smoking patients. ⋯ Secondary care staff should also make every effort to help people to stop smoking and should communicate effectively with primary care--opportunities during hospitalisation are frequently missed. Specialist smoking cessation clinics have an essential role in providing more intensive specialist treatment and the expertise to partner and support the primary care effort. Smoking cessation is one of the most cost-effective healthcare interventions that can be made.