Journal of the Royal Naval Medical Service
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Case Reports
Penetrating brain injury: a case of survival following blast fragmentation injuries to the head.
We present a case of penetrating head injuries caused by blast fragmentation, along with other serious injuries (including to the arms, face and neck), where a good recovery was made despite an Injury Severity Score (ISS) of 75. We suggest that survival and outcome are reliant on several factors and cannot be predicted from ISS, velocity of penetrating injury or presenting Glasgow Coma Scale (GCS) alone.
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Upper respiratory tract infections (URTIs), generally termed colds, sore throats and coughs, are common presentations in primary care. This article discusses the clinical picture, management, significant differential diagnosis, and specifically, when antibiotics may be required for an URTI.
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The identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) >15. ⋯ The sensitivity of the WTT at identifying patients with an ISS> 15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.
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Musculoskeletal pain is a common presentation in military patients. If not managed effectively it can have a detrimental effect on both the individual and the ship/unit. This article aims to examine how to thoroughly assess a military patient presenting with acute musculoskeletal pain; to provide the practitioner with a framework for effective pain history taking, and to help identify and exclude rare but serious causes of pain - 'red and yellow flag concepts'. Key management steps and appropriate interventions for managing acute, benign musculoskeletal pain are discussed and related to the varying environmients where the patient may be encountered.