This study assessed the clinical use of three ultrasound measurements; median nerve cross-sectional area, median nerve flattening ratio and palmar displacement of the flexor retinaculum, for the diagnosis of carpal tunnel syndrome. The measurements were made in 20 carpal tunnel sufferers and 20 controls. The sensitivity, specificity and predictive values of each were calculated in various clinical settings. Values for each of the three variables were significantly different in the patient and control populations. The differences we recorded were smaller than those found in previous studies. The tests had a sensitivity of 72% and a specificity of 90%. Alterations in the morphology of the carpal tunnel in patients with carpal tunnel syndrome can be measured in the district general hospital setting. The measurements described maybe a useful non-invasive confirmatory test in patients in whom there is a strong clinical suspicion of carpal tunnel syndrome. However, they would be of no benefit in epidemiological surveys of populations with a low incidence of carpal tunnel syndrome.

The use of arterial tourniquets in prehospital emergency care has been fraught with controversy and superstition for many years despite the potential utility of these tools. This review examines this controversy in the context of the history of the tourniquet as well as its recent use in surgery and modern battlefield casualty care. Safe prehospital tourniquet use is widespread in the military and is based on sound physiologic data and clinical experience from the surgical use of tourniquets. The physiologic, pathophysiologic, and clinical underpinnings of safe tourniquet use are reviewed here, along with a discussion of alternatives to tourniquets. Prehospital settings in which tourniquets are useful include tactical emergency medical services (EMS) and other law enforcement environments as well as disaster and mass casualty incidents. Beyond this, we present arguments for tourniquet use in more routine EMS settings, in which it may be beneficial but has heretofore been considered inappropriate. Protocols that foster safe, effective prehospital tourniquet use in these settings are then presented. Finally, we discuss future directions in which tourniquet research and other initiatives will further enhance the safe, rational use of this potentially life-saving tool.

No abstract

No abstract