Journal of accident & emergency medicine
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To examine the management of traumatic pneumothorax in a department where some of these injuries do not receive chest drains. ⋯ Chest drain insertion for small or moderate sized traumatic pneumothoraces, in the absence of other significant injuries or the need for intermittent positive pressure ventilation (IPPV), may be unnecessary.
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The case is reported of a young woman who suffered a wedge fracture of C7 due to axial loading with a flexed spine, in an injury caused by barfly jumping. The fracture was unstable and required surgical stabilisation. In this case the seriousness of the injury was not realised at first because neck radiographs were not taken at her initial assessment in accident and emergency.
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To devise a proforma for clinical documentation of psychiatric illness in an accident and emergency (A&E) department, since A&E senior house officers (SHOs) have little psychiatric experience before starting their jobs. ⋯ A standard form for documenting psychiatric history, designed according to local needs, is useful and should be available in A&E departments.
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Tension pneumoperitoneum developing in a middle aged asthmatic male during resuscitation after a respiratory arrest is reported. This was associated with bilateral tension pneumothorax and caused severe respiratory embarrassment which was relieved by needle decompression, after decompression of the pneumothoraces. The chest is not the only body cavity that can contain air under tension.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Should accident and emergency nurses request radiographs? Results of a multicentre evaluation.
To evaluate whether waiting time in accident and emergency (A&E) departments is shortened when experienced nurses request peripheral limb radiographs before a patient is assessed by a doctor. ⋯ 14 min can be saved by getting the patient to see the nurse first; however, because nurses in three out of four hospitals requested more radiological examinations than doctors, overall only 4 min waiting time was saved when peripheral limb radiographs were requested by nurses. The findings are somewhat against expectations but do identify that specific training and constant monitoring is essential if nurses are to request peripheral limb radiographs, as reflected in hospital C results.