Emergency medicine journal : EMJ
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Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature. ⋯ It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.
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Randomized Controlled Trial
Relationship between Trendelenburg tilt and internal jugular vein diameter.
To evaluate the relationship between Trendelenburg tilt and internal jugular vein (IJV) diameter, and to examine any cumulative effects of tilt on the IJV diameter. ⋯ Increasing the degree of Trendelenburg tilt increases the lateral diameter of the IJV. Even a 10 degrees tilt is effective. The cumulative effect of tilt (that is, the effect of the previous angle) is not significant. Ultrasound guided cannulation is ideal, but in its absence Trendelenburg tilt will increase IJV diameter and improve the chance of successful cannulation. While 25 degrees achieved optimum distension, this may not be practical and may be detrimental (for example, risk of raised intracranial pressure).
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A prospective study was conducted by the Scottish Trauma Audit Group (STAG) in A&E of Edinburgh Royal Infirmary to examine clinical practices in the management of head injured patients pre- and post-inception of the SIGN guidelines published in August 2000.1607 patients attended the department in two separate one month periods at equal intervals pre- and post-guidelines publication. The majority of patients with a SIGN indication for admission were admitted (93% pre- and 92% post-guidelines). For skull x ray (SXR) requests, in the pre-guidelines group, 92% of admitted patients with a SIGN indication for x ray had a SXR: this figure dropped to 79% post-guidelines. 36% of patients with a SIGN indication for CT actually had a scan pre-guidelines: this figure increased to 64% post-guidelines.57% of patients pre-guidelines and 44% of patients post-guidelines were discharged from A&E in accordance with the SIGN recommendations. ⋯ Despite publication of the SIGN guidelines and positive reinforcement in A&E and at ward level, practice has not changed significantly. Where our practice did not adhere to SIGN recommendations, there was no untoward sequelae. For published national guidelines to be effective, a formal audit structure with regular feedback is necessary to ensure a continued change in clinical practices.
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To derive a clinical decision rule for people with traumatic brain injury (TBI) that enables early identification of patients requiring specialised trauma care. ⋯ This decision rule identified among a cohort of head injured patients evaluated in the ED the majority of those who urgently required specialised trauma care. The rule will require prospective validation in injured people presenting to non-tertiary care hospitals before implementation can be recommended.
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Case Reports
Reduction of the posterior pelvic ring by non-invasive stabilisation: a report of two cases.
We demonstrate radiological evidence that an external pelvic splint is effective at reducing open book pelvic fractures. Its use in the pre-hospital and emergency department settings should be encouraged in the initial management and resuscitation of patients with pelvic fractures.