The importance of hand anatomy in the accident and emergency department: assessment of hand anatomy knowledge in doctors in training

2009 ◽  
Vol 34 (5) ◽  
pp. 682-684 ◽  
Author(s):  
J. K. DICKSON ◽  
G. MORRIS ◽  
M. HERON
Keyword(s):  
Early Recognition ◽  
Tendon Injuries ◽  
Junior Doctors ◽  
Accident And Emergency ◽  
Postgraduate Level ◽  
Anatomical Knowledge ◽  
Accident And Emergency Department ◽  
Anatomy Knowledge ◽  
Serious Injuries ◽  
Anatomy Teaching

Good anatomical knowledge is essential for the early recognition of severe or significant hand injuries in the Accident and Emergency (A&E) department, in particular nerve, vascular or tendon injuries. In 1992, Murphy and Olney assessed hand anatomy knowledge in junior doctors. We have repeated this study 16 years on. The 2008 cohort performed worse in response to every question asked and in some areas significantly so. We discuss the results in relation to the recognition of serious injuries and also with regards to anatomy teaching in medical schools and at postgraduate level.

scholarly journals A Retrospective Review of Patients with Necrotizing Fasciitis Presenting to an Emergency Department in Hong Kong

2002 ◽  
Vol 9 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Fp Sin ◽  
Mc Yuen ◽  
Kw Lam ◽  
Cw Wu ◽  
Wk Tung
Keyword(s):  
Emergency Department ◽  
Necrotizing Fasciitis ◽  
Early Recognition ◽  
High Dose ◽  
Accident And Emergency ◽  
Patients With Diabetes ◽  
Wrong Diagnosis ◽  
Radical Debridement ◽  
Accident And Emergency Department ◽  
Clinical Records

Background Necrotizing fasciitis is a soft tissue gangrenous infection that require early diagnosis, radical debridement and broad-spectrum antibiotics. Aim To review the clinical spectrum and outcome of necrotizing fasciitis in Kwong Wah Hospital during a period of 18 months. Method Cases of necrotizing fasciitis were identified from discharge statistics for the period January 1999 to June 2000. Accident and Emergency Department (AED) notes and clinical records after admission were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome. Results Fifteen cases of necrotizing fasciitis were found but two of them had wrong diagnosis made. Of the thirteen cases, ten were male and three were female. The average age was 61.7 years old. Most of them presented with different combinations of swelling, pain, erythema and fever. They attended the emergency department with an interval of 3.5 days from the onset of symptoms. Risk factors were identified in 64% of patients, with diabetes mellitis (DM) and hypertension (HT) being the most common. Monomicrobial and polymicrobial infections were equally common in our study. Streptococcus pyogene was the most common pathogen. Only two NF (18%) were diagnosed in AED. Six patients were admitted to either surgical or orthopaedic wards and all of them underwent operations within 24 hours although two of them died. Other five patients were managed in medical ward and four of these patients underwent delayed operations but survived whilst one of them died despite of early surgical intervention. Overall mortality was 23%. Conclusions This condition affects a wide age group and have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in its management.

Road Traffic Accident Related Morbidity as Seen in an Accident and Emergency Department

1981 ◽  
Vol 26 (2) ◽  
pp. 121-124 ◽  
Author(s):  
D. J. Galloway ◽  
A. R. Patel
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Education Programme ◽  
Small Sample ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
Serious Injuries

This paper describes some of the findings of a prospective study of victims of road traffic accidents arriving at the Western Infirmary's Accident and Emergency Department over a period of 12 months. More than half the accidents occurred during leisure hours thus likely to stretch the resources of the hospital services. More than a third of the total number of patients were young male drivers. Serious injuries were significantly more often sustained among pedestrians who were often older. Victims of motor-cycle accidents less often escaped serious injuries. Blood ethanol studies on a small sample suggested that male pedestrians were often highly intoxicated. A public health education programme is regarded as a primary measure in preventing a large proportion of serious morbidity and mortality especially amongst pedestrians.

scholarly journals Investigating the Benefits of Integrated Anatomy Instruction: A Cognitive Load Theory Perspective

2021 ◽  
Vol 13 (3) ◽  
pp. 1-14
Author(s):  
Saiful Bahri Talip ◽  
Zul Izhar Mohd Ismail ◽  
Siti Nurma Hanim Hadie
Keyword(s):  
Learning Styles ◽  
Cognitive Load ◽  
Cognitive Load Theory ◽  
Design Theory ◽  
Integrated Approach ◽  
Future Application ◽  
Junior Doctors ◽  
Load Theory ◽  
Anatomy Knowledge ◽  
Anatomy Teaching

Declining anatomy knowledge of junior doctors has been linked to clinical error judgement and medicolegal litigation. To overcome the problem, anatomy educators have introduced many teaching initiatives during undergraduate study that might promote anatomy knowledge acquisition and retention, including anatomy teaching using integrated instruction. Anatomy instruction can be integrated in terms of its contents and teaching approach. Learning from integrated anatomy instruction allows students to relate anatomy subjects with different subdisciplines and to comprehend related clinical context for future application. On the other hand, the integrated approach for anatomy teaching caters to different types of learning styles, therefore ensuring optimal learning. Nevertheless, causal relationships between integrated anatomy instruction and student learning has never been explicitly explored. Hence, this article aims to unearth the elements of integrated anatomy teaching that promote learning through instructional design theory, namely, cognitive load theory (CLT).

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

Use of an accident and emergency department observation ward in the management of head injury

1993 ◽  
Vol 80 (8) ◽  
pp. 1079-1079 ◽  
Author(s):  
A. F. T. Brown ◽  
G. J. Wilkes ◽  
C. T. Myers ◽  
R. E. Maclaren
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department

1993 ◽  
Vol 18 (1) ◽  
pp. 115-118 ◽  
Author(s):  
J. STEVENSON ◽  
I. W. R. ANDERSON
Keyword(s):  
Emergency Department ◽  
Complete Resolution ◽  
Wound Care ◽  
Duration Of Treatment ◽  
Mean Delay ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
The Mean ◽  
Careful Assessment

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.

scholarly journals Radiological features of body packers: An experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport

2018 ◽  
Vol 25 (4) ◽  
pp. 202-210
Author(s):  
Ho Kai Patrick Tsang ◽  
Cheuk Kei Kathy Wong ◽  
Oi Fung Wong ◽  
Wing Lun William Chan ◽  
Hing Man Ma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hong Kong ◽  
Body Packing ◽  
Radiological Features ◽  
International Airport ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Body Packers ◽  
Solid Form ◽  
Hong Kong International Airport

Background: Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking. Objectives: To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine. Methods: This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated. Results: Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (p<0.05). The liquid cocaine packets appeared irregular with indistinct border in majority of cases (p<0.05). The solid form packets were mostly opaque to faeces while liquid cocaine had variable density (p<0.05). Most solid form packets had homogeneous content which was in contrast to the heterogeneous content in liquid cocaine (p<0.05). Conclusion: Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

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