Journal of accident & emergency medicine
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The case is reported of a man shot with a distress flare from a range of about 3 m. The flare caused a large cavity deep in the pectoral muscles. There should be a high index of suspicion about the extent of the injury in all types of penetrating trauma.
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Comparative Study
Medical involvement in prehospital care--a transatlantic comparison.
The role of doctors in prehospital care in the United Kingdom and the USA was compared using information obtained from a visit to the city of Houston emergency medical service (Houston, Texas) and from a review of published reports. The involvement of full time specialist emergency medical services physicians has been crucial to the development of improved standards of practice within American prehospital care. The specialty of accident and emergency medicine should support provision of medical advice to the ambulance services by closer liaison with ambulance service trusts and the formalisation of training in prehospital care to specialist registrars.
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Case Reports
Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency.
Severe accidental hypothermia in an urban environment is usually associated with drug or alcohol abuse or serious illness in elderly or debilitated patients. In the presence of cardiovascular instability, extracorporeal rewarming by cardiopulmonary bypass is the gold standard of treatment of such patients. Three cases of profound hypothermia with circulatory collapse are presented. ⋯ All three cases had a serum potassium in the normal range at the start of treatment. Where facilities exist, extracorporeal rewarming can be performed in A&E for patients with profound hypothermia and circulatory collapse. Cardiopulmonary resuscitation must be continued throughout the rewarming process.
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To examine 105 successive negligence claims against NHS accident and emergency (A&E) departments in the United Kingdom and to highlight risk management points. ⋯ SHOs employed in A&E departments need careful training and supervision, with ready access to senior medical advice, both clinical and radiological. Most errors leading to claims appear in retrospect to have been simple failures of history taking, physical examination, interpretation of radiographs, and communication. Poor quality notes imply substandard care. About half the claims were found to be indefensible.
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To investigate the use of a simple intrasound device in the detection of malleolar fractures in the accident and emergency (A&E) department. ⋯ The use of intrasound in the detection of malleolar fractures cannot be relied upon alone, but it may help to limit the number of x rays taken unnecessarily. A further study is proposed to confirm these findings.