Injury
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The objective of this study was to assess the availability of pre-prepared equipment for needle cricothyroidotomy, and the knowledge of staff in its use in Accident and Emergency (A&E) departments in Great Britain. A telephone survey was undertaken of all A&E departments seeing more than 30,000 new patients per year. 184 hospitals were contacted. 98% of the doctors agreed to be interviewed. 47% of the departments had made provision for immediate use of needle cricothyroidotomy. 45% of the doctors interviewed were fully conversant in the use of needle cricothyroidotomy. Provision of equipment for immediate use of needle cricothyroidotomy in A&E departments is generally inadequate. All departments should ensure that such equipment is immediately accessible, and that the staff is regularly trained in its use.
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Ten patients with clinically suspected neuromas following amputation were submitted for ultrasound examination. Neuromas in seven of the ten patients were identified as the cause of pain with ultrasound guided infiltration of local anaesthetic. ⋯ This small study demonstrates that ultrasound is an effective method for identifying and localising neuromas in amputation stumps. This leads to reduced dissection and may lead to a better outcome in these patients.
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The use of fluoroscopic screening in the orthopaedic theatre is a necessary operative aid in many procedures. Modern systems give good image resolution and allow the production of per-operative hard-copy prints. This study was performed to compare these prints with postoperative radiographs in 41 patients who underwent internal fixation for an ankle fracture in a 6-month period. ⋯ In the other five cases, the differences were not significant. In none of the cases did the check X-ray effect a change in postoperative management. We therefore suggest that if per-operative hard-copy prints are obtained from the fluoroscopic images, postoperative radiographs of the ankle are only necessary in exceptional circumstances.
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Over a 10-year period we reviewed the records of 370 consecutive patients with potentially penetrating abdominal wounds (48 gunshot and 322 stab wounds). Selective non-operative management for abdominal stab wounds was introduced, guided by serial physical examination. In our study the terms therapeutic and non-therapeutic laparotomies were used, the latter comprising negative as well as insignificant findings. ⋯ Delayed laparotomy did not cause death or increase morbidity. Our results support the concept of selective non-operative management of abdominal stab wounds using repeated physical examination. Peritoneal perforation and haemoperitoneum should not be an indication for routine laparotomy.