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xiaowuheng金虫 (正式写手)
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DIAGNOSIS Only children presenting with Type I fractures can be discharged without referral, but they are more difficult to diagnose than Type I I or III. Definitive diagnosis of the type and severity of fracture is made by X-ray Gartland stipulates: 'Every child with a suspected elbow fracture should have an X-ray examination of both elbows'. But modern prartice didates that exposure to radiation is rarely justified so films of the uninjured side are unnecessary particularly if prartitioners know how to assess paediatric X-rays reliably. Thornton and Gyll warn that appearances can be misleading if true antero-posterior and lateral X-ray views are not provided, and that undisplaced fractures can be missed if radiographic positioning is inexact. However, in cases of gross elbow deformity, a lateral view alone yields enough evidence of a fully displaced fracture. If children are in such pain that moving the elbow at all is inhumane then one X-ray in the most comfortable position is enough pre-operatively. Requesting and interpreting X-rays are central to the management of supracondylar fractures. But there is no consensus about which patients should undergo X-ray and individual departments have their own protocols. The author's experience shov« that many departmental protocols do not allow ENPs to request X-rays for small children, often those who are under five years of age. Several studies have shown however that there is no significant difference in the appropriateness of requests made by ENPs compared to SHOs. Tye recommends that training in X-ray interpretation should be mandatory for nurse practitioners so that this skill is accepted as part of their role. |
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2楼2011-04-29 11:23:57
xiaowuheng
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