Injury
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The aim of effective clinical handover is seamless transfer of information between care providers. Handover between paramedics and the trauma team provides challenges in ensuring that information loss does not occur. Handover is often time-pressured and paramedics' clinical notes are often delayed in reaching the trauma team. Documentation by trauma team members must be accurate. This study evaluated information loss and discordance as patients were transferred from the scene of an incident to the Trauma Centre. ⋯ By documenting where deficits in handover occur we can identify points of vulnerability and strategies to capture this information.
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Selective non-operative management based on clinical assessment has been shown to be a generally safe approach in the management of penetrating stab wounds of the torso. However there will be a subset of patients who fail selective non-operative management. This audit focuses on the failures. ⋯ Clinical assessment accurately predicts the need for mandatory laparotomy following a stab wound to the torso. In patients who do not meet the indications for mandatory laparotomy and who are subjected to non-operative management 20% will come to surgery. A subgroup may only be recognised as requiring surgery after more than 12h. These patients are at risk of delay associated morbidity. There are particular anatomical sites and structures which are prone to error.
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To evaluate a two-tiered trauma activation protocol in a major trauma referral hospital in Australia. ⋯ The two-tiered trauma activation protocol is effective in identifying patients with major trauma from those with minor trauma. There were no deaths in undertriaged patients.
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Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. ⋯ The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated.