Archives of emergency medicine
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The purpose of this study was to investigate the efficacy of femoral nerve blocks in patients with fractures of the neck of the femur. Thirty-six patients with femoral neck fractures attending the accident department over a three month period received femoral blocks from one of the two authors. ⋯ In all six patients who reported no benefit, the block failed objectively. There were no complications of the procedure.
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A case of alcoholic beverage sensitivity is described which presented as acute bronchospasm. Such reactions in asthmatics are not uncommon, though their severity may be underestimated in the presence of intoxication. Indeed, such patients may be dismissed as suffering only from the effects of intoxication with obvious consequences.
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Comparative Study
Accuracy of detection of radiographic abnormalities by junior doctors.
This study assessed the ability of junior doctors in accident and emergency to detect radiographic abnormalities. Their assessments of 505 radiographs taken at nights and weekends over a period of 8 months and showing abnormalities were examined. Each assessment by a senior house officer (SHO) was compared with the subsequent diagnosis of a radiologist of senior registrar or consultant status. ⋯ It is considered that the proportion of missed abnormalities gives a truer index of SHOs' abilities. No improvement in performance was evident over the 6-month period of the SHOs tenure of post. It is argued that it is unrealistic to expect accident and emergency SHOs to acquire this complex skill simply through experience and that more formal training and guidance is needed.
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The various guidelines for the administration of tetanus toxoid and antitetanus immunoglobulin are not only complicated, but also have never been supported by any scientific experimental studies. This study has measured the antibody levels in a random sample of 157 patients presenting to an accident and emergency department. Levels were measured before and after boosting doses. ⋯ In fact, no patient in the study had a level below the 'protective level'. Bearing in mind the small number of patients in the study, it could be argued that the level of immunity against tetanus in the United Kingdom is likely to be higher than assumed. If this is proven to be correct, then the length of time between booster injections of toxoid can be extended and the use of Human Antitetanus Immunoglobulin can be further restricted.