Journal of accident & emergency medicine
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To provide information about children with a skull fracture in the Edinburgh area, since head injury is the single most important traumatic cause of death in children over 1 year of age. ⋯ To reduce the incidence of head injuries, and the associated morbidity and mortality, the following are required: identify at risk groups; promote accident prevention; publicise the findings and guidelines concerning childhood head injuries; ensure that all children with head injuries have appropriate investigations and begin treatment as early as possible; establish clinical audit; and set up regional rehabilitation teams.
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To assess the workload generated by police inquiries to an accident and emergency (A&E) department and the adherence of medical staff to departmental guidelines relating to these inquiries. ⋯ Police inquiries generate a significant workload for an A&E department, often at clinically busy times. Medical staff need further education to ensure that patient confidentiality is respected while assisting the police with their investigations.
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To review the activity of the nurse triage process. ⋯ The use of video in the triage room allows assessment of the triage process and is a valuable aid to training. Additionally, a potential visual audit tool has been identified.
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Case Reports
Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis.
Tension pneumothorax in a large man was inadequately drained by needle thoracocentesis with a 4.5 cm cannula. Unsuccessful needle thoracocentesis of a clinical tension pneumothorax in a large patient should be followed immediately by chest drain insertion, without local anaesthetic, as dictated by clinical urgency. If the clinical situation is still not improved other diagnoses should be considered.
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To determine present staffing levels, to find out problems, and to request solutions. ⋯ There are marked variations in recruiting ability across the country. Presently teaching hospitals are having no major difficulty, but others are only able to obtain junior doctors from outside the United Kingdom. Public expectations and charter standards are difficult to maintain. There is evidence of increasing stress among career and senior A&E medical staff. There is an inexorable but slow increase in year on year workload.