Deep Venous Thrombosis is a major problem among hospitalized patients. However, despite its importance, there is a lack of appropriate prophylaxes being instituted. This, together with the poor performance of the participating clinicians in Part 2 of the present study,indicate that there are significant problems in The Canberra Hospital regarding DVT prophylaxes and that steps need to be taken to overcome these problems.

Objective-To determine the aetiology, frequency, presentation, and outcome of blunt cervicocerebral arterial dissection presentations. Patients and methods-Cases were retrospectively identified through the stroke registers at Royal Melbourne Hospital (a tertiary teaching hospital) and Geelong Hospital (a regional referral centre). Medical notes were then reviewed. Results-A total of 18 cases were identified, with ages ranging from 28 to 53 years. Fifty five per cent of the injuries sustained were to the internal carotid artery and 45% to the vertebral artery. The majority of the injuries were either spontaneous or associated with trivial forces. Other causes included motor vehicle accidents, falls, and cervical manipulations. Fifty five per cent ofpatients complained of significant neck pain before presentation. Most patients had delayed presentations, with only 39% presenting on the day of the incident. Seventy eight per cent presented with a neurological deficit. Initial computed tomography was normal in 71% of patients. The majority of patients were managed with anticoagulation, and had minimal functional deficit on discharge. Other treatment modalities included surgery (one patient) and thrombolysis (two patients). One patient was managed conservatively. Conclusions-The incidence of blunt cervicocerebral arterial dissection is unknown; however it is an uncommon diagnosis. The most common presentation is that of a delayed neurological event. Initial brain computed tomography is usually normal. Minimal adverse outcomes at discharge were noted in patients treated with anticoagulation only. (J Accid Emerg Med 1999;16:422-424)

Australia's population is ageing. Statistics predict that by the year 2021, 17.8% of our population will be over the age of 65 years. These statistics are reflected in most Western nations. The elderly represent an increasing proportion of emergency department patients. They are generally more acute on presentation, they get admitted more frequently, and account for an increasing proportion of admissions to intensive care units. The elderly trauma patient will increasingly consume more resources than patients from any other age group. There are significant differences in physiology and response to trauma between the elderly patient and the young. Airway compromises, a decrease in lung compliance, a change in cardiovascular haemostasis and the prevalence of pre-existing disease all contribute to increase morbidity and mortality in a patient with an already limited physiological reserve. Many studies demonstrate an increased mortality in hospitalized elderly trauma patients. For those who die from traumatic insult, death is mainly due to multiorgan system failure. The long-term functional outcome of the elderly trauma patient has been investigated by a number of authors. One study showed that only 8% of survivors returned to independent living 1 year post-polytrauma. Another more encouraging study showed that 89% of survivors of blunt multiple trauma after 38 months were independent and living at home. Ethical issues have been raised regarding the appropriateness of care for the severely injured elderly patient given today's ever-shrinking hospital finances and bed shortages. Today's environment is very challenging as frequently, the clinician is forced to make an economic decision on who will take the last critical care bed, which is a far from optimal situation.

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