Archives of emergency medicine
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Elbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray. The sensitivity of this test was 90.7% (95% confidence limits 80.7-100.7) and the specificity 69.5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.
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Since their introduction into the United Kingdom, Advanced Trauma Life Support Courses (ATLS) have preferentially offered places to Consultants and Senior Registrars. It is usual, however, for the initial resuscitation of the seriously injured patient to be performed by relatively inexperienced junior staff. It is incumbent upon those medical staff who are ATLS providers or instructors to design local courses, based upon ATLS principals, to train their junior staff in a structured approach to managing these patients. We describe one such local course which may serve as a model for others.
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To determine whether ambulance crew triage trauma patients appropriately. ⋯ At present the activities of paramedics are poorly supervised, and pre-hospital management by paramedics may be jeopardizing patient care.
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Fifteen consecutive patients who had been resuscitated from cardiac arrest and transferred immediately to an Intensive Care Unit were studied. Measurements of intraarterial pressure, cardiac output and systemic vascular resistance demonstrate that 'cuff' blood pressure may not always be related to intraarterial pressure or cardiac output and cannot be used for diagnostic, therapeutic, or prognostic purposes. ⋯ The palpation of a pulse is a simple and important indication of spontaneous cardiac activity. However cardiac output must be measured and it's adequacy cannot be inferred from this basic clinical measurement.