Emergency medicine journal : EMJ
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Gastric tube insertion in the intubated patient can prove both difficult and frustrating. A simple modification to the standard gastric tube and corresponding technique of insertion is described which enables directional manoeuvring of the tube tip. Experience with the technique is described in a case series of 10 patients.
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The purpose of this national survey of UK ambulance services was to provide an up-to-date assessment of service provision for children in the prehospital setting and to identify the challenges faced in providing optimal services to this group. ⋯ Despite improvements, paediatric care by front-line personnel is limited by resource and availability of staff with key skills. Accepted standards are often lacking. Collaborative audit, research and training initiatives should be carried out between services and acute trusts to meet local service requirements. This will reduce variation and maintain the safety of patients and quality of care.
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Case Reports
Chest wall necrosis and empyema resulting from attempting suicide by injection of petroleum into the pleural cavity.
Hydrocarbon poisoning such as that of benzene and petroleum usually occurs accidentally by inhalation or ingestion of these cytotoxic chemical compounds. Intravenous or subcutaneous injection of petroleum compounds with intent of suicide or abuse is an extraordinary event that can result in local damage or systemic toxicity such as tissue necrosis, abscess formation, respiratory system failure and partial damage to the kidneys, the brain and the nervous system. In this article, we describe a 31-year-old man who was admitted in the surgery ward of Besat Hospital. ⋯ With segmentectomy and flap reconstruction of the chest wall wound, he recovered completely and was discharged. Our report supports early and aggressive surgical debridement of necrotic tissue, thoracotomy tube insertion and special care of respiratory system toxicity after chest wall injection of petroleum. Regarding the basis of clinical findings and paraclinical investigations that measure lung parenchymal necrosis with empyema and fistula formation, thoracotomy and decortication with or without lung tissue resection and also chest wall reconstruction are the standard treatment of these patients.