Causes and patterns of injury from ladder falls.

OBJECTIVES: To review all ladder fall injuries seen in a community ED and to identify patterns of injury, factors that contribute to falls, and what pre-event and event factors could have reduced the likelihood of a fall or a resulting injury. METHODS: This was a retrospective, observational study involving patients who presented to a community hospital ED from January 1993 through December 1995 with injuries from a ladder fall. The medical records of all patients were reviewed. Patients then underwent a structured telephone interview to provide additional information about the circumstances of the fall. RESULTS: There were 59 patients who sustained injuries relating to ladder falls. All were adults, aged > 18 years (mean 42.9 +/- 16.2 years), were predominantly male (93%), and had fallen a distance of 1-15 feet (mean 7.2 +/- 3.6 feet). Thirteen percent were admitted to the hospital, and there was 1 death. Fractures were observed in 21 patients (36%) and usually involved an extremity (77%). There was no relationship between the distance fallen and the occurrence of fracture. Other primary injuries included sprain (27%), contusion (24%), laceration (10%), abrasion (3%), and subdural hematoma (2%). Of the 59 patients, 42 (71%) were contacted directly. Most falls (79%) resulted from excessive reaching or incorrect ladder placement. Fifty percent of the described falls were occupationally related. CONCLUSIONS: Falls from ladders, both in the occupational and nonoccupational settings, often result in significant injury. Simple safety measures may have prevented the majority of falls in this study. Public health efforts should emphasize education on safe ladder practices and techniques to reduce the possibility of injury in the event of a fall.

Air bag safety.

STUDY OBJECTIVE: To describe injuries associated with deployment of air bag passive-restraint systems in use in the United States. DESIGN: Retrospective review of data collected by the National Highway Traffic Safety Administration (NHTSA) from 1980 to 1994. PARTICIPANTS: Occupants of air bag-equipped vehicles who were involved in crashes on US roads. RESULTS: Of 618 reported occupant injuries related to air bag deployment, an overwhelming majority were classified as minor (96.1%). Most occupants sustained abrasions, contusions, and lacerations. The face (42.0%), wrist (16.8%), forearm (16.3%) and chest (9.6%) were the most frequently injured body areas. CONCLUSION: Most injuries related to air bag deployment are minor and must be viewed in the context of the potentially life-threatening injuries they prevent.

Use of thrombolytic therapy in a heart transplant recipient with acute myocardial infarction.

We report the case of a 54-year-old long-term heart transplantation survivor who presented to the emergency department with acute myocardial infarction and was treated successfully with thrombolytic therapy. The case is discussed, and pertinent literature is reviewed.

Studies on in vitro degradation and in vivo digestion of a slow ammonia releasing urea product.

a slow ammonia releasing urea product (Uromalt) has been produced by autoclaving and drying of germinated barley and urea. In vitro degradability of nitrogen (IVDN, Raab et al., 1983) was in average 62 +/- 9% in 4 hours, compared to 76 +/- 8% with an autoclaved and dried mixture of urea and not-germinated barley. Mixtures of urea with Leucaena l. or Azadarichta indica (Neem cake) showed degradabilities of about 80 and 93%, respectively, when dried at 39 degrees C, but of 65% when dried at 100 degrees C. For comparison, degradabilities of proteins of ground nut, guar, sunflower, mustard, rape and sesame cake/meal have been determined. When growing lambs were fed a ration containing 15% Uromalt, faecal N-excretion was significantly higher on the expense of urinary N-excretion, compared with groups fed isonitrogenous rations containing soya bean meal with or without urea and molasses. N-retention was not significantly affected. It is concluded that this slow ammonia releasing urea product can be used in cases where molasses or other feedingstuffs rich in rapidly fermentable carbohydrates are not available.