Brit J Hosp Med
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The last two decades have witnessed major advances in genetic sequencing which have led to more accurate identification of women at risk of developing breast cancer and calculating the associated cancer risk. This review discusses the current genetic mutations conferring risk of developing breast cancer and the management pathway for these women with identifiable mutations as well as those with a strong family history for breast cancer. ⋯ There are several treatment options ranging from surveillance to risk-reducing surgery. Risk reduction surgery has been popularised by celebrities who are carriers of breast cancer genes, and raised public awareness of breast cancer genetics and associated risk.
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Trauma affecting the chest wall, even in isolation, can carry a significant morbidity and mortality and thus appropriate management is vital. Consequences of chest wall trauma may include significant pain, altered chest wall mechanics, hypoventilation, infection and respiratory failure. In order to best determine the appropriate management, risk stratification tools have been developed to identify patients at highest risk of complications who would most benefit from more invasive management strategies. ⋯ The analgesic options range from multimodal oral analgesia to invasive regional anaesthetic techniques such as thoracic epidurals, paravertebral catheters, intercostal nerve blocks and fascial plane blocks. Other important considerations include provision of appropriate oxygen therapy, ventilation support and physiotherapy. For a selected group of patients with the most significant injuries, surgical rib fixation may be appropriate if chest wall mechanics are sufficiently impaired.
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Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.