Accidental mobile phone card ingestion.

Accidental overdose, poisoning and foreign-body ingestion are common presentations to the emergency department. Usually, the ingested material is a common drug or household product. We present an unusual case of accidental ingestion where the foreign body was a mobile phone simulation (SIM) card.

Audit of nasal fracture management in accident and emergency in a district general hospital.

RATIONALE: Nasal fractures are a common occurrence in accident and emergency and dealt with by inexperienced senior house officers. This can lead to inappropriate X-rays being performed, no proper documentation of septal haematomas and often no follow-up with a specialist team leading to in some cases complex cosmetic surgery whereas simple manipulation may have sufficed. METHOD: We report an ambispective audit carried out on nasal fracture management in a busy district general hospital over a 6-month period. RESULTS: 46 patients were seen 24 in the first 3 months and 22 the next three. 10 had nasal X-ray performed initially on audit. Nine had no documentation of septal haematoma and seven had no follow-up arranged. After appropriate education and the setting up of a department protocol based on best practice, the next cycle was repeated. Two nasal X-rays were performed looking for foreign bodies, all patients had appropriate documentation of septal haematoma and appropriate follow-up. CONCLUSION: Appropriate education and implementation of departmental guidelines can result in more effective and efficient use of resources when dealing with nasal fractures in accident and emergency.

Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial.

BACKGROUND: Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial--a multicentre international collaboration--aimed to confirm or refute such an effect by recruiting 20000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. METHODS: 10008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. FINDINGS: Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21.1%] vs 893 [17.9%] deaths; relative risk 1.18 [95% CI 1.09-1.27]; p=0.0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0.22) or time since injury (p=0.05). INTERPRETATION: Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.