Journal of the Royal Naval Medical Service
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Exertional heat illness remains a major cause of morbidity and occasional mortality within the Armed Forces. This review explores the normal responses to heat, known causes of exertional heatstroke, and suggests possible answers to the question of why one member of a military unit collapses with heat stroke, while matched controls at his side remain unaffected.
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Case Reports
Surgical repair of intercostal pulmonary hernia secondary to cough induced rib fracture.
Intercostal pulmonary hernia, a protrusion of lung parenchyma with overlying pleural membranes through an abnormal defect in the thoracic cage, is an uncommon phenomenon. Rib fractures caused by coughing similarly represent an infrequently occurring clinical presentation. Pulmonary herniation through an intercostal defect caused by cough fractures has been described twice in the literature to our knowledge. We present a case of pulmonary herniation secondary to cough fracture in a chronic bronchitic, successfully treated by thoracotomy with application of the basic principles of hernia repair, and a discussion of the mechanisms of injury.
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Multicenter Study
The use of local anaesthesia in peripheral venous cannulation: current practice of junior doctors.
To determine the rate of use of local anaesthetic in peripheral venous cannulation by pre-registration house officers and to determine reasons why they do not use it. ⋯ Despite good clinical evidence that the pain of peripheral venous cannulation can be successfully obviated using local anaesthetic, the rate of use by pre-registration house officers is low. It is suggested that during formal cannulation training, more emphasis be placed on the provision of analgesia. This should aim to increase the quality of care to those patients requiring intravenous cannulation as well as offering other potential benefits to doctors.