British journal of hospital medicine
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The mainstay of early management following severe head injury (less than 8 on the Glasgow coma scale [GCS]) remains urgent cardiopulmonary resuscitation, triage, transfer to a neurosurgical centre, emergency CT scanning and appropriate surgical intervention (Rose et al, 1977; Seelig et al, 1981; Langfitt and Gennarelli, 1982; Bricolo and Pasut, 1984). Subsequent therapy usually includes a period of intensive care with or without artificial ventilation (Becker et al, 1977; Bruce et al, 1978; Marshall et al, 1979). Intracranial pressure (ICP) monitoring is employed in many centres during the first post-traumatic week, however conservative or aggressive the management regimen is.
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Preoperative chest X-rays are performed routinely in many surgical units. But is the procedure of value? Do the benefits to patients justify the costs and risks? In this paper, the evidence is reviewed and the conclusion reached that routine preoperative chest X-rays should be abandoned in elective non-cardiopulmonary surgery.