Journal of accident & emergency medicine
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A case of occipital condylar fracture in a multiply injured and unconscious motorcyclist is reported. This injury was clinically unsuspected but found on the lowest cuts of head computed tomography. It is shown that this site is often inadequately imaged when scanning the head and neck in victims of trauma. ⋯ It is noted that types 1 and 2 are stable injuries but type 3 is potentially unstable. A retrospective analysis of 30 head computed tomography scans in trauma cases revealed that in only 16 were the occipital condyles adequately imaged. It is emphasised that vigilance is required to detect fractures of the occipital condyle and that it should be standard practice to include this area when performing computed tomography of the head in trauma victims.
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Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised "primary" indications for ultrasound in emergency medicine. ⋯ The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.
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(1) To describe a process approach to the improvement of pain management in emergency departments. (2) To compare analgesia ordering and administration practices for patients with acute fractures before and after implementation of a nurse managed, titrated intravenous narcotic policy. ⋯ This study demonstrates that a process approach to improving pain management that resulted in both changes in drug administration and pain assessment and management processes made a significant and sustained change to analgesia ordering and administration practices for patients with long bone fractures in an emergency department.
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To evaluate the efficacy of open chest cardiac compressions for the resuscitation of pre-hospital cardiac arrest patients presenting with non-shockable rhythms on arrival at the emergency department. ⋯ Open chest cardiac compressions provide effective perfusion, enabling correction of ventilation parameters and showing clinical signs of adequate perfusion. However, acidosis was not corrected and the use of 50 mEq sodium bicarbonate was ineffective.
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Four patients with intracranial penetrating injuries from screwdrivers are presented. Two cases were fatal; the others were left with functional deficits. In two of the patients a penetrating injury was not suspected initially because the history was limited and the significance of the small entry wounds were not appreciated. Unless these wounds are carefully examined a penetrating injury is easily overlooked.