Injury
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The Nuneaton derailment presents some unique problems as well as more common ones. The deployment of services presents a challenge and interrelationships are important (Keep, 1966). This challenge was mainly well met at Nuneaton, though there were difficulties in organizing medical care at the scene. ⋯ Instructions to staff should be revised and new staff briefed on arrival. Reliefs must be arranged and should be labelled and have job cards passed on to them. Abbreviated colour-coded action cards might be useful.
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The consequences of a jelly fish sting on the arm are described. The effects of the venom and inadequate early treatment resulted in vascular spasm in the forearm and necrosis of the digits. The toxicological properties of jelly fish venom are briefly described.
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Pneumothorax is a well known immediate complication of penetrating chest injuries, but its late occurrence is not widely recognized. In a retrospective study of 56 patients who sustained stab wounds of the chest, 6 (10 per cent) developed pneumothorax between twelve hours and three days after injury. Combined thoraco-abdominal stab wounds were present in three patients and surgical emphysema was also apparent in three other patients. We conclude that pneumothorax of late onset may be commoner than has been suspected and this emphasizes the need for observation in hospital for 48 h and for serial radiography of the erect chest to detect this dangerous complication.
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A retrospective review of 500 fractures of the tibia was undertaken. In 316 adults we assessed the influence of various forms of violence on the rate of healing and the incidence of complications in fractures of the shaft of the tibia. Other factors pertinent to fracture healing in the shaft of the tibia were also investigated and their relative importance was assessed.
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Occlusion of the axillary artery occurred in a man with erect dislocation (luxatio erecta) of the shoulder. This combination of injuries has not previously been reported. The arterial injury was demonstrated by arteriography and repaired by a vein graft. There was an associated fracture of the greater tuberosity of the humerus, which required open reduction and internal fixation.