International journal of clinical practice
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Int. J. Clin. Pract. · Jan 2002
Use of a customised endotracheal tube for tracheostomy in the large neck.
Patients with huge necks who require a tracheostomy pose particular problems. This paper describes a technique to customise a standard endotracheal tube to make a long tracheostomy tube. This can be used as a short-term emergency airway. It is recommended because it is cheap, simple, safe and potentially life saving.
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Int. J. Clin. Pract. · Jan 2002
Comparative StudyReferral patterns to a district general hospital gastroenterology outpatient clinic: implications for the 'two-week target'.
We defined the pattern and appropriateness of GPs' new-patient referrals to a large district general hospital gastroenterology department, and assessed the implications for workload in the context of the recently introduced 'two-week target'. Prospective data were collected on all new referrals over a two-month period and 426 new appointments were included, from which data were available on 390. ⋯ Nineteen per cent of all GP referrals were classified as urgent and 6% of these had a malignancy. Fifty per cent of patients with malignancy were not perceived as meriting an urgent referral by the GP Gastroenterology outpatient facilities are already overstretched and the implementation of the two-week target will add considerable strain to the current resources, with little gain in identifying malignancy.
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A foreign body causing obstruction of the larynx is usually removed by coughing, blows to the back, chest thrusts, abdominal compression or finger sweep manoeuvres on the unconscious victim. In extremis, crichothyroidotomy or emergency tracheostomy may be the only life-saving option. ⋯ A case of supraglottic impaction of the larynx by a piece of sausage occurred in our hospital; the patient was semiconscious. It was managed successfully by a carefully timed laryngoscope blade being inserted into the mouth without the aid of sedative drugs.
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This report describes a complex syndrome of injuries occurring in a young female who was a back seat passenger wearing a lap-belt restraint in a high-speed road traffic accident. As a consequence of the forced flexion distraction injury of her lumbar spine, she sustained a fracture-subluxation of the first lumbar vertebra in association with a jejunal perforation and extensive small intestinal mesenteric laceration. She also had a large traumatic hernia of the anterior abdominal wall, which was overlooked at primary laparotomy. This report highlights collectively the classical combination of injuries associated with the lap-belt syndrome and demonstrates the importance of carefully inspecting the anterior abdominal wall for deficiencies, because traumatic herniation may be easily overlooked.
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Int. J. Clin. Pract. · Sep 2001
Case ReportsThalamic tumour presenting as frontal lobe dysfunction.
A 64-year-old man presented with a change in personality and behaviour but with no neurological deficits. He exhibited impaired executive functions, apathy, unsteadiness of gait and falling; he lacked insight and exhibited purposeless behaviour, making loud grunting noises. A CT scan at 6 months revealed no abnormality, but at 9 months CT and MRI showed a bilateral thalamic tumour. The presenting symptoms had similarities to frontal lobe dysfunction progressing to dementia.