Articles: emergency-services.
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All attendances at Waikato Hospital accident and emergency department since 1980 have been coded and stored in computer files. Fifty thousand children under age 15 years attended A&E between 1980 and 1986. Age-specific attendance rates were determined and major reasons for consultation examined. ⋯ Sporting injuries dominated the 10-14 age group with 28% of all accidents being sports related. Road traffic injuries reflect the mobility of each age group with 7% of accidents in the under 1 group, rising to 14% for all children over 4 years. The implications of these patterns are discussed.
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The medical record serves numerous functions. It provides chronologic evidence of patient evaluation, treatment, and response to therapy, and a means to review the quality of the care. Communication among members of the health care team regarding the patient's status and plan of care also occurs by means of the medical record. ⋯ For the trauma patient, mechanisms of injury, GCS, trauma score (or essential components), spinal immobilization, and the status of airway, breathing, and circulatory systems also must be recorded. The importance of accurate and comprehensive documentation on every medical record should not be underestimated. (National Standards of Emergency Nursing Practice dictate that nurses are responsible for the accurate documentation of patient care.) The medical record provides both important information about the patient's clinical condition and the corner-stone for lawsuits in alleged medical negligence. It is the legal documentation of ongoing patient care delivery and the chronicle of the patient's responses to therapeutic interventions.
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The authors describe the case history of a patient who was stabbed in the back of his neck with a knife and who later presented with a Brown-Séquard syndrome attributable to cervical spinal cord damage. Myelography and CT revealed a compressive extradural lesion shown at exploratory operation to be a loculus of cerebrospinal fluid (CSF). The loculus had formed as a consequence of leakage of CSF through a dural tear caused by the knife. ⋯ The necessity of obtaining a clear history and of performing a thorough clinical examination is explained. The need to admit patients in whom stab wounds of the neck have transgressed subcutaneous fat is reiterated. Early referral to a neurosurgeon is advised for those patients with neurological deficits.