The end for the 'Roman Sandal': an observational study of methods of securing chest drains in a deployed military setting.

INTRODUCTION: There is ongoing debate regarding the optimal method of securing chest drains in trauma patients. Various courses describe methods for chest drain insertion, but little has been published to identify the best method to secure the drain. AIM: This article aims to examine differences in approach to securing chest drains and the security of the methods used. METHOD: Whilst in a deployed medical treatment facility, 26 clinicians from various specialties and nationalities were asked to secure a pre-placed drain. A 32F drain was placed in a manikin and the clinicians were given a chance to prepare their equipment. They were given a choice of suture and their attempts were observed by one of the researchers. The attempts were timed and photographed. A second researcher, who had not observed the technique, then assessed the security of the drain. RESULTS: 15/26 clinicians used a 'Roman Sandal' technique with 5/26 proving to be insecure. Other techniques used showed no failure. The rate of consultant-secured failure was 12.5% compared to 40% for registrars and 33% for General Duties Medical Officers. CONCLUSIONS: The type of suture used made no difference, but the traditional 'Roman Sandal' method was insecure. Knots tied close to the skin and those that bit into the drain were shown to be most effective.

The management of the acutely swollen ankle.

Patients presenting with an acutely swollen ankle are common in both the military and civilian settings. Accurate diagnosis is vital, as there are various potentially serious causes. This article aims to review the common causes of an acutely swollen ankle, as well as the rarer causes, with their significant consequences.

Significant neurological presentations in commando trained personnel: case studies and consideration of differential diagnosis.

A 27-year-old Royal Marine presented to his sickbay following two episodes of sudden onset visual disturbance. A subsequent MRI Scan demonstrated ischaemic changes in the territory of his right posterior cerebral artery. Transthoracic echocardiography was normal but a bubble contrast study was strongly positive indicating the presence of a relatively large patent foramen ovale (PFO). He underwent endovascular closure of his patent foramen ovale and was subsequently upgraded back to full duties. A 35-year-old Army Sergeant presented with sudden onset collapse, right sided weakness, dysarthria and confusion. He was airlifted to a Host Nation hospital and following a normal CT head underwent thrombolysis in the Emergency Department. This was unsuccessful but a CT guided embolectomy led to complete resolution of symptoms. Subsequent transthoracic echo revealed a PFO. He underwent endovascular closure and has since been returned to full duties. The incidence of PFO is common affecting 27% of the population but the incidence of ischaemic stroke in young adults (aged 15-45 years old) is rare. This maybe linked to the size of the PFOs in symptomatic individuals. These case reports emphasise the requirement for further investigation of individuals presenting with collapse and persisting neurology. Differential diagnosis and initial management for primary care and pre-hospital clinicians is also reviewed.

Nonintrusive optical measurements of aircraft engine exhaust emissions and comparison with standard intrusive techniques.

Nonintrusive systems for the measurement on test rigs of aeroengine exhaust emissions required for engine certification (CO, NO(x), total unburned hydrocarbon, and smoke), together with CO(2) and temperature have been developed. These results have been compared with current certified intrusive measurements on an engine test. A spectroscopic database and data-analysis software has been developed to enable Fourier-transform Infrared measurement of concentrations of molecular species. CO(2), CO, and NO data showed agreement with intrusive techniques of approximately ?30%. A narrow-band spectroscopic device was used to measure CO(2) (with deviations of less than ?10% from the intrusive measurement), whereas laser-induced incandescence was used to measure particles. Future improvements to allow for the commercial use of the nonintrusive systems have been identified and the methods are applicable to any measurement of combustion emissions.

The Rorschach: does it have a future?

Recent evidence suggests that in spite of an increasingly critical attitude by many clinicians towards the use of projective techniques, the use of these techniques has not faltered over the years. Insofar as the Rorschach continues to be the most popular projective instrument, its scientific status is critically examined in the present paper. The problems inherent in examining an instrument which has engendered a number of quite distinct scoring systems are noted, and the conclusion is advanced that notwithstanding such problems there seems little likelihood that the Rorschach will experience any significantly diminished popularity in the future.