Cerebrospinal fluid shunts.

The evaluation of hydrocephalic shunts is a common problem seen in emergency departments. The emergency medicine practitioner must be aware of the various types of apparatus, the functional considerations of the shunt, and the potential complications of obstruction. Shunt malfunction, either from obstruction or infection, can be life-threatening, and a reasonable approach for delineating the underlying problem and its severity is presented. Close involvement of the neurosurgeon is imperative because definitive care is almost always the purview of the consultant.

A radiographic comparison of short-arm cast and plaster and fiberglass wrist splints.

Prepackaged plaster and fiberglass splints are used in many emergency departments. This study evaluated the effectiveness of short-arm cast (SAC), volar fiberglass wrist splint (FWS), and volar plaster wrist splint (PWS) in limiting wrist range of motion. Ten healthy male volunteers between the ages of 18 and 35 years were included. Each wrist on each volunteer was immobilized with SAC, FWS, and PWS. Wrist radiographs were taken with each appliance and angular motion measured by two radiologists. PWS performed better than FWS in flexion, extension, radial deviation, and ulnar deviation (all P < .05). PWS was not statistically different than SAC in limiting flexion, extension, or radial deviation, although SAC performed better in ulnar deviation (P < .05). PWS limits wrist motion more effectively than FWS and performs in a similar manner to SAC in flexion, extension, and radial deviation.