J Emerg Med
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State-controlled hospital services in South Africa are racially determined, with separate facilities for the different racial groups. The recent violence seen in and around Pietermaritzburg has resulted in an increasing number of blacks attending hospitals other than their own racially defined institution. ⋯ One third of shootings ended fatally. Possible reasons why some blacks attend hospitals other than their own racially defined, are explored.
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Most reports of penetrating chest wounds include all regions of the thoracic wall. Recent studies of abdominal wounds stratified by entrance site have demonstrated significant differences in injury pattern that influence initial assessment and management. This is an analysis of 135 consecutive patients admitted to the Denver General Hospital with penetrating injuries to the posterior chest, done in an effort to elucidate operative indications. ⋯ Overall, 28 patients (23%) with posterior penetrating chest wounds required early surgical intervention; 38% following a GSW compared to 20% due to a SW. Only 9 patients (8%) required thoracotomy while 19 (15%) underwent laparotomy. The most frequent indication for thoracotomy was persistent chest hemorrhage, and for laparotomy, positive diagnostic peritoneal lavage.
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The emergency physician must be well versed in diagnosing forearm and wrist injuries. Although many of these injuries are readily apparent, others require more sophistication to appreciate. Careful attention to radiographic findings given the assistance of a well-directed history and physical examination is imperative. Both the more common and the more subtle injuries will be discussed.
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An athletic young male presented with right calf pain following a twisting injury during a soccer game. Other than apparently severe calf pain, no symptoms or signs of compartment syndrome were noted. The patient later returned with lateral and anterior compartment syndrome, and suffered partial loss of peroneal nerve and muscle function despite fasciotomy. ⋯ Pain out of proportion to the apparent injury and a history of chronic leg pain with exertion may be helpful in identifying these patients prior to development of more obvious signs and symptoms. The diagnosis of acute compartment syndrome may be confirmed by compartmental pressure measurement. Prompt intervention is indicated once the diagnosis is established.