ABSTRACT
BACKGROUND: Immediate management of closed fracture-dislocations of the ankle requires urgent reduction and immobilisation of the ankle prior to definitive surgery. METHODS: The management of 23 patients attending the accident and emergency department of a district general hospital with this type of injury were reviewed retrospectively. RESULTS: Paramedic reduction was attempted in 1 of the 22 patients brought by ambulance. Triage categorisation was inappropriate in 14 patients. Unnecessary pre-reduction radiographs were obtained in 8 patients. Reduction was initially inadequate in 2 patients, and no post-reduction splintage was applied in a further 2 patients. Recording of skin and neurovascular status was inadequate in the majority of the patient's notes. CONCLUSIONS: The necessary urgent reduction and splintage is being delayed in some cases because of inadequate injury recognition, inappropriate triage categorisation and unnecessary radiographs.
Subject(s)
Ankle Injuries/therapy , Fractures, Closed/therapy , Immobilization , Joint Dislocations/therapy , Adolescent , Adult , Aged , Ankle Injuries/diagnostic imaging , Emergency Medical Services , Female , Fractures, Closed/diagnostic imaging , Humans , Joint Dislocations/diagnostic imaging , Male , Middle Aged , Musculoskeletal Manipulations/methods , Radiography , Retrospective Studies , Splints , TriageABSTRACT
A case report describes the successful aspiration of a non-deflating suprapubic urinary catheter by passing a cannula directly down the fistula tract. It is a relatively safe and simple procedure that can be performed in an accident and emergency department.
Subject(s)
Device Removal/methods , Urinary Catheterization , Catheters, Indwelling , Female , Humans , Middle Aged , Suction , Urinary Catheterization/adverse effectsABSTRACT
Several studies have shown that plain film radiography (PFR) is unnecessary for most patients with abdominal pain. To evaluate the current-day utilization of PFR, we retrospectively reviewed 224 patients presenting to an emergency department with acute abdominal pain. Plain film radiography was performed in 55.8% (125/224) of patients, but only 10.4% (13/125) of these were diagnostic. Most patients with non-specific abdominal pain had radiographs (62%, 31/50), suggesting that PFR was being used as a routine investigation. Plain film radiography has little in the diagnosis of most causes of abdominal pain and should therefore not be used routinely. Confining radiography to patients with suspected gastrointestinal obstruction, perforation or ischaemia, unexplained peritonism, or renal colic would have included all our diagnostic films and reduced the utilization of PFR to 20.5%. The reasons for inappropriate requests and issues concerning the use of emergency radiography are discussed. Staff education, departmental protocols and increased out-of-hours ultrasonography facilities are recommended to reduce the inappropriate use of PFR.
Subject(s)
Abdomen, Acute/diagnostic imaging , Radiography, Abdominal/statistics & numerical data , Unnecessary Procedures , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Competence , Emergency Service, Hospital , Female , Hospitals, District , Hospitals, General , Humans , Male , Medical Audit , Middle Aged , Retrospective StudiesABSTRACT
We report two similar rare types of fracture of the lower end of the humerus sustained in fit young adults while throwing a ball. Both cases were seen within 1 week in a busy accident and emergency (A&E) department. The types of fracture in each case are unusual and, in the past, have been attributed to fatigue or to a repetitive strain pattern.
