Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether CT scans of the upper cervical spine are necessary in trauma patients with altered mental status and normal plain radiographs. A total of 572 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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A short cut review was carried out to establish whether antibiotics reduce the incidence of meningitis in patients with compound depressed skull fracture. Altogether 198 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.
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The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. ⋯ Specific education and treatments encourage a behaviour after whiplash injury that is conducive to more rapid recovery, and provides the whiplash patient with insight into the mediators of chronic pain. The article describes in practical terms how to use education, reassurance, a more judicious use of therapy, and exercise to achieve this goal. Practical guidelines are provided on educating the patient about other symptoms that may cause concern.
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Cervical spine fractures associated with diffuse idiopathic hyperostosis (DISH) are less common than those associated with ankylosing spondylitis and can occur after minor trauma in patients asymptomatic of the disease process. This case report describes a hyperextension injury of the neck in a patient unknown to have DISH, which resulted in an angulated C3/C4 fracture. The position of the fracture was improved by placing the neck in flexion with immediate improvement in the patient's neurological deficit.
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To demonstrate trends in trauma care in England and Wales from 1989 to 2000. ⋯ Most of the case fatality reduction for trauma patients reaching hospital over the 1989-2000 time period occurred before 1995 when there was most marked change in the initial care of severely injured patients.