Emergency medicine journal : EMJ
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Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
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Traditional management of Clinical Scaphoid Fractures has been to immobilise the wrist for 10-21 days and then reassess the injury. Birmingham Children's Hospital (BCH) has offered an Early MRI service for these patients for 12 years. The aim is to MRI the wrist within a few days of injury to get a definitive diagnosis and reduce unnecessary immobilisation. The objective of this review of the Early MRI service, was to analyse: Age, Sex and Hand dominance Percentage of actual scaphoid fractures & other carpal/radial fractures Time from presentation to MRI scan ⋯ It is possible to offer Early MRI scanning for Clinical Scaphoid Fractures, and most commonly our patients waited 3 days, reducing the length of immobilisation. A large number of other injuries were identified which were missed on initial Xrays. Half of all subjects have a fracture, however only half of these were scaphoid fractures. Only approximately a quarter of scans were normal, and therefore immobilised unnecessarily. Boys are more likely to actually have a scaphoid fracture on MRI than girls.
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There is a lack of information available about how the skills of Foundation Doctors develop over their time spent working in the Emergency Department (ED). Knowing this could better focus future training. We wanted to examine to what extent working in the ED influences confidence of Year 2 Foundation Doctors in managing common conditions seen in the ED and in performing practical procedures. ⋯ The ED provides good exposure for improving the skills of foundation doctors. The greatest improvement was in areas doctors had not experienced elsewhere (e.g. paediatrics, suturing, diagnosing fractures).