Injury
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Immediate diagnosis and surgical treatment of acacia thorn injury results in complete cure. Delay or late presentation results in morbidity. The features of this disorder are presented in a series of 22 patients. The principles of treatment can be applied to all other types of thorn injury.
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A series of cases is described in which sciatic nerve block (by the lateral approach of Guiardini et al., 1985), with or without femoral nerve blockade, proved useful in the manipulation of tibial and ankle fractures without recourse to general anaesthesia. A case is presented in which this approach was the method of choice.
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In a prospective study lasting 6 months, all missed injuries in patients visiting the casualty department or admitted to the orthopaedic department of Aarhus Amtssygehus were registered and analysed. A total of 15,806 patients attended the casualty department and 783 patients were admitted to the orthopaedic department. ⋯ Twenty-three injuries were missed in 17 patients in the orthopaedic department making a missed injury rate of 2.2 per cent. Re-examination of all patients and matching radiographs reduced the number of missed injuries significantly.
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High tension electrical injuries have a high morbidity and mortality. Carbon fibre and graphite used in the manufacture of fishing rods gives them superconductor qualities. We report a case which teaches an important lesson not only in the management of such severe injuries, but also in their prevention.
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The results of resuscitation of the multiply-injured patient have been subjected to audit at this district teaching hospital (Lewisham) over a 6-month period in 1988. During this period the trauma team was called to 30 patients in the accident department and one death was identified as being potentially preventable. ⋯ There is now little doubt that the creation of a network of trauma centres in the United Kingdom will decrease the occurrence of preventable deaths in multiply-injured patients. However, until this network is introduced, each hospital must consider in the interim how best it can respond to the immediate needs of the multiply-injured patient.