Journal of accident & emergency medicine
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To examine the management of traumatic pneumothorax in a department where some of these injuries do not receive chest drains. ⋯ Chest drain insertion for small or moderate sized traumatic pneumothoraces, in the absence of other significant injuries or the need for intermittent positive pressure ventilation (IPPV), may be unnecessary.
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To devise a proforma for clinical documentation of psychiatric illness in an accident and emergency (A&E) department, since A&E senior house officers (SHOs) have little psychiatric experience before starting their jobs. ⋯ A standard form for documenting psychiatric history, designed according to local needs, is useful and should be available in A&E departments.
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Case Reports
Oesophageal rupture in the course of conservative treatment of bleeding oesophageal varices.
Fatal oesophageal rupture is described as a complication of the management of bleeding oesophageal varices with repeated sclerotherapy and tamponade using the Sengstaken-Blakemore tube. The importance of chest radiographs is stressed in the early detection and prevention of malposition of the Sengstaken-Blakemore tube, as inflation of the gastric balloon in the oesophagus can result in oesophageal rupture.
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Tension pneumoperitoneum developing in a middle aged asthmatic male during resuscitation after a respiratory arrest is reported. This was associated with bilateral tension pneumothorax and caused severe respiratory embarrassment which was relieved by needle decompression, after decompression of the pneumothoraces. The chest is not the only body cavity that can contain air under tension.
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Tourniquet of hair and thread fibres may become tightly wrapped around a child's digit. The resultant ischaemia may lead to tissue necrosis and autoamputation. ⋯ The need for prompt recognition and complete removal of all fibres is stressed. The possibility of non-accidental injury should be born in mind.