RESUMEN
BACKGROUND: The aims of this study were to present the demographics and mechanisms of facial injury in UK children, and to establish the nature and anatomical location of facial injury in this age group. METHODS: Patient data were collected retrospectively over 1 year from a paediatric Emergency Department in South East Scotland. Medical notes were examined for all patients coded on the electronic patient record as having any facial injury. RESULTS: 593 patients attended with a facial injury. The median age of patients was 4.7 years. (IQR 2.4-7.5 years.), and the male to female ratio of facial injuries was 2:1. Injuries were predominantly from falls. Assault or violence was uncommon. Most common sites of facial injury were the lower third of the face and dento-alveolar injury. Facial fractures were rare and radiographic facial imaging was infrequently performed. Only eight facial fractures were diagnosed. 4.5% of all patients were admitted to hospital; 23% of the children were referred on to other specialities for follow-up, of these over half were to a dentist. CONCLUSIONS: A large number of children presented with facial injuries during the study period. Facial lacerations, oral trauma and dental trauma were the most common injuries. The majority of patients were dealt with without admission or referral to another speciality.
Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Traumatismos Faciales/epidemiología , Niño , Preescolar , Huesos Faciales/lesiones , Traumatismos Faciales/clasificación , Traumatismos Faciales/etiología , Femenino , Estudios de Seguimiento , Humanos , Laceraciones/epidemiología , Masculino , Fracturas Maxilares/diagnóstico , Fracturas Maxilares/epidemiología , Admisión del Paciente , Estudios Retrospectivos , Escocia/epidemiología , Distribución por Sexo , Índices de Gravedad del TraumaRESUMEN
Upper labial frenal tear in infants is classically taught as having associations with non-accidental injury. Collection of data for a 12-month period in our paediatric facial injury study revealed that this injury pattern is common in ambulant children and was associated with other facial trauma. In assessing the possibility of this injury being due to abuse, the importance of the mobility of the child and the mechanism of the injury are paramount.
Asunto(s)
Maltrato a los Niños/diagnóstico , Frenillo Labial/lesiones , Diagnóstico Diferencial , Traumatismos Faciales/etiología , Humanos , Lactante , MasculinoRESUMEN
In September 2002, the National Institute of Clinical Excellence (NICE) issued guidelines for England and Wales suggesting that ultrasound guidance should be used for all electives, and should be considered for most emergency, central venous catheterisations.1 These guidelines propose a major change of practice for most clinicians practising in UK Emergency Departments. There are also resource and training implications. In this paper we systematically review the literature to establish what evidence exists for the routine use of ultrasound guidance in the placement of central venous catheters in adult patients attending the Emergency Department, and provide an overview of the practical elements of this procedure.
Asunto(s)
Cateterismo Venoso Central/métodos , Servicio de Urgencia en Hospital/normas , Ultrasonografía Intervencional/métodos , Ultrasonografía/métodos , Adulto , Cuidados Críticos/métodos , Medicina Basada en la Evidencia , Agencias Gubernamentales , Humanos , Metaanálisis como Asunto , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Ultrasonografía Intervencional/normas , Reino UnidoRESUMEN
This study's objective was to examine the nature, cause and frequency of injury resulting from equestrian sport in paediatric patients attending two accident and emergency departments. We recorded the attendances of patients aged less than 16 years with equestrian-related trauma in 1 year. Demographic details, injury, mechanism of injury, rider experience and use of protective equipment were noted. There were 41 attendances (39 female, two male, median age 12 years). Thirty-one were injured while mounted, 10 while dismounted. The commonest group of injuries were soft tissue injuries of the lower limb (13 cases), soft tissue injuries of the upper limb (12 cases), fractures of the upper limb (nine cases), and minor head injury (seven cases). There was one case of severe head injury. Two patients required admission to hospital. The commonest mechanism of injury in the mounted group was a fall or throw (23 cases), in the dismounted group injuries were most commonly the result of being trodden on or being kicked (seven cases). The majority of equestrian-related trauma was minor in this study. The possibility of severe trauma exists. Emergency physicians working in areas where equestrian sport is popular should be aware of the likely injuries and their treatment.
Asunto(s)
Accidentes por Caídas/prevención & control , Traumatismos en Atletas/epidemiología , Caballos , Heridas no Penetrantes/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Adolescente , Distribución por Edad , Animales , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/prevención & control , Mordeduras y Picaduras/epidemiología , Mordeduras y Picaduras/prevención & control , Niño , Preescolar , Traumatismos Craneocerebrales/epidemiología , Tratamiento de Urgencia , Femenino , Fracturas Óseas/epidemiología , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Equipos de Seguridad , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: To determine whether psychosocial assessments of patients presenting to the Accident and Emergency (A&E) Department at Addenbrooke's Hospital, Cambridge, with deliberate self-harm are recorded adequately in the case notes, using the criteria of the 1994 Royal College of Psychiatrists' consensus statement on managing adult deliberate self-harm in hospital. DESIGN: A cross-sectional study of case notes. SUBJECTS: A total of 338 patients (accounting for 404 episodes of deliberate self-harm) who presented consecutively between 1 January and 30 June 1996. RESULTS: 56% of episodes resulted in admission to a general hospital bed. In only 11% of conscious patients were adequate psychological assessments recorded in the case notes. Little psychosocial information was recorded in the notes of those patients discharged without follow-up from accident and emergency. CONCLUSIONS: In the A&E department of this teaching hospital, there is inadequate recording of important psychological information in the case notes of patients who present with deliberate self-harm.
Asunto(s)
Conducta Autodestructiva/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Registros de Hospitales , Hospitalización , Humanos , Masculino , Conducta Autodestructiva/diagnósticoRESUMEN
BACKGROUND: Established practice is for the relatives of critically ill patients to be excluded from the clinical area during resuscitation. We aimed to discover whether relatives wanted to be present during the resuscitation of a family member and whether witnessing resuscitation had any adverse psychological effects on bereaved relatives. METHODS: In this pilot study, relatives of patients who required resuscitation were given the option to remain with the patient during resuscitation or were not given this choice and directed to the relatives' room (control group). The unit of randomisation was the patient who required resuscitation and not the relatives. One close relative was paired with each patient. All relatives were accompanied by a chaperone who gave emotional support and provided technical information on the resuscitation. Relatives were followed up 1 month after the resuscitation. We used a questionnaire to ask about the decision to be present or absent during resuscitation. Bereaved relatives also completed five standardised psychological questionnaires to assess anxiety, depression, grief, intrusive imagery, and avoidance behaviour. FINDINGS: 25 patients underwent resuscitation (13 in witnessed resuscitation group, 12 in control group). Three patients in the witnessed group survived, all the control-group patients died. Two relatives in each group were lost to follow-up. Thus, eight relatives who witnessed resuscitation and ten control-group relatives were followed up. There were no reported adverse psychological effects among the relatives who witnessed resuscitation, all of whom were satisfied with their decision to remain with the patient. The clinical team became convinced of the benefits to relatives of allowing them to witness resuscitation if they wished, so the trial was terminated. INTERPRETATION: In the context of the emergency department, routine exclusion of relatives from the resuscitation room may no longer be appropriate.
Asunto(s)
Aflicción , Familia/psicología , Resucitación/psicología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pruebas Psicológicas , Estrés PsicológicoRESUMEN
A case of non-accidental injury to an infant caused by the discharge of an air pistol is presented, the first such case to be reported. A two-month-old baby was shot at close range by his father with a .177 air pistol. A false account of the cause of the injury was given by the father and initially supported by the mother. The pellet penetrated the skin in the centre of the child's forehead and lodged in the anterior wall of the sagittal sinus. It was removed under general anaesthetic and the child made an uncomplicated recovery. The father was subsequently convicted and jailed for the assault. The relevant literature on air weapon injuries and bizarre forms of child abuse is discussed.
Asunto(s)
Maltrato a los Niños/diagnóstico , Traumatismos Craneocerebrales/etiología , Medicina Legal , Heridas por Arma de Fuego/diagnóstico , Adulto , Humanos , Lactante , Masculino , Reino Unido , Heridas por Arma de Fuego/complicacionesRESUMEN
The use of airguns in attempted suicide is uncommon. In such instances, the surface wounds caused by discharged pellets may be inconspicuous or appear deceptively trivial to the medical examiner. Airgun pellets however are easily capable of penetrating the skull or abdominal cavity when fired at the close ranges involved in suicide attempts. The destructive power of these weapons at close range should not be underestimated. We describe three cases of attempted suicide and review the other nine cases reported in the medical literature: of the 12 suicide attempts there were three fatalities. Seventeen out of a total of 19 pellets fired penetrated either the cranial or peritoneal cavity or damaged deep structures. Most of the victims were male. The majority of wounds were right sided. Four of the attempts were extremely determined, involving repeated discharge of the airgun or the use of other means to effect suicide.
Asunto(s)
Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Craneocerebrales/diagnóstico por imagen , Armas de Fuego , Intento de Suicidio , Heridas por Arma de Fuego/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Adulto , Traumatismos Craneocerebrales/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/cirugíaRESUMEN
Two cases of traumatic asphyxia in young children are reported. The first was a 2 year old child run over at low speed by the front wheels of a delivery van. He made an uncomplicated recovery. The second child was pinned to the floor by an empty chest of drawers in an unwitnessed accident. He was discovered in cardiac arrest and resuscitation was unsuccessful. The outcome following traumatic asphyxia is a product of duration of compression and the weight involved. Considerable weight can be tolerated for a short period, whereas a comparatively modest weight applied for a longer period may result in death.
Asunto(s)
Asfixia/etiología , Traumatismos Torácicos/complicaciones , Accidentes Domésticos , Accidentes de Tránsito , Preescolar , Resultado Fatal , Humanos , Lactante , MasculinoRESUMEN
Patients who suffer a cardiac arrest with alcohol present in their blood may, theoretically, differ from patients who arrest in the absence of alcohol. Alcohol may induce certain lethal arrhythmias, deter strenuous resuscitation in the pre-hospital phase and influence the effectiveness of resuscitative manoeuvres. In this study, 150 patients presenting to an Accident and Emergency department with cardiac arrest were tested for the presence of alcohol in their plasma. 49 patients had detectable plasma alcohol and analysis of their pre-hospital resuscitation revealed no significant differences when compared with the 101 patients in whom no alcohol was detected. No particular arrhythmia predominated in the alcohol group, and patients who had alcohol detected in their blood were just as likely to be successfully resuscitated, in terms of both restoration of spontaneous circulation and survival to hospital discharge. The effect of significantly elevated plasma alcohol levels on cardiac arrest outcome remains unclear, however, as only 7/150 patients had plasma alcohol levels above the legal driving limit.