J Trauma
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Rectal examination with guaiac testing is a standard part of the emergency department evaluation of acutely traumatized patients. Its major role is in the recognition of occult bowel injury. We questioned its efficacy in detecting occult rectal injury in patients with penetrating trauma. ⋯ Sensitivity was 100% (8/8) when the two were combined. Our findings suggest that guaiac testing is not accurate enough to rule out the presence of occult rectal injury. The result of guaiac testing must not influence the decision to further evaluate patients with high-risk injuries.
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Advanced-level general surgery residents were surveyed about their interest in providing trauma care upon completion of their residency training. Questionnaires were sent to 1,795 residents and 886 (49%) replied. Two thirds of the residents stated that trauma was a rewarding field, but only 18% wanted it as a career or as a major part of their practice. ⋯ Primary reasons for these negative feelings were the large amount of nonoperative care rendered in treating blunt trauma patients and the unsavory type of patients encountered with most penetrating trauma injuries. Lifestyle issues were important but were not rated as high as other factors. Complaints about the structure of current trauma rotations in many institutions and the negative impact of many trauma surgeons as role models were frequently cited as reasons for respondents not pursuing trauma care as a career interest.
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Simultaneous dislocation of the elbow and the proximal radioulnar joint is a rare occurrence. Closed reduction led to a cure in a 6-year-old boy with transverse divergent dislocation of the elbow.