Archives of emergency medicine
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A prospective study was carried out during the month of November, 1990 in the A&E Department, St John's Hospital, Livingston in order to assess the extended role of the A&E nurse and their ability to request X-rays prior to patients being seen by a doctor. A total of 579 randomly selected patients were triaged by A&E Department nurses. ⋯ Of those patients who had an X-ray after seeing a doctor, more than 90% fell within the X-ray triage criteria but had not had an X-ray requested by the triage nurse. Overall, nurses were shown to request X-rays correctly and efficiently with the result that patients had to spend less time in the A&E Department.
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Following the introduction of the Milch technique as the preferred method of reduction of anterior shoulder dislocations in an A&E department, a retrospective study of the technique was carried out. A total of 187 patients with anterior shoulder dislocations were included. ⋯ In 73% of the Milch cases either no analgesia or sedation or Entonox alone was used. This study shows that the Milch technique can successfully be used by inexperienced staff to reduce dislocated shoulders with a reduction in the requirements for sedation and anaesthetics.
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During a recent 4-year period, 381 patients were admitted with injuries sustained from falls. Equal numbers of patients were less than and greater than 50 years of age and included 53 children (less than or equal to 16 years) and 214 elderly (greater than or equal to 55 years). Falls from heights occurred predominantly in young males (mean age 34.2 years), were most commonly job or recreation related and resulted in higher injury severity scores (ISS). ⋯ In patients under 55 years, deaths resulted from fall-related central nervous system (CNS) injury and/or multisystem trauma. In patients over 55 years, fatalities were most commonly related to pre-existent medical conditions. Based on a review of this experience, we conclude that: (1) unlike other causes of blunt and penetrating trauma, both sexes are equally at risk from fall-related injuries but sex incidence is age related; (2) falls from heights are more common in men; (3) advanced age and pre-existing medical conditions account for the increased morbidity and mortality following falls and; (4) cost containment measures for fall-related trauma must consider not only injury severity, but the age and pre-existent medical conditions of the patient.