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The management in a regional unit of 158 patients with thoracic trauma resulting in respiratory failure is described. Emphasis is placed on the need for accurate diagnosis of intraabdominal trauma in the presence of chest injury. Peritoneal tap is advocated, both to avoid unnecessary laparotomy and to diagnose hæmoperitoneum when intraabdominal signs are obscured by those of the thoracic injury. Following laparotomy on a patient with significant pulmonary trauma, artificial ventilation is necessary for some days, but when the trauma chiefly involves the chest, an opportunity exists to manage the patient by pain relief alone. Forty‐five patients suffering respiratory failure following injury to the chest and abdomen were managed, and 12 died, while 35 needed artificial ventilation.

During the period April, 1968, to April, 1973, all patients admitted to Royal Newcastle Hospital with respiratory failure following chest injury were managed in the Acute Respiratory Unit. The great majority resulted from motor vehicle accidents. A total of 130 patients suffered respiratory failure following chest injury, and were all seen by at least one of us. Only 21 patients had isolated chest injury, 109 having multiple injuries. Twenty-four patients died, nine from associated cerebral contusion. The place of artificial ventilation in the proper management of chest injuries is discussed and particular. stress is laid on those patients with conditions or injuries likely to lead to resptratory fatlure. In this category are those patients with significant flail segment, associated head or abdominal injury, the obese, and those with pre-existing chest disease.

Six patients out of a total of 1,137 adults treated for drug overdose died during the period M ay, 1968 to June, 1973. Their case histories are summarized, and the conclusion drawn that, whilst death from drug overdose is unusual, increased vigilance particularly for the unsuspected secondary diagnosis or complication, is nccded if there is to be any further reduction in the already small mortality rate. ,INTRODUCTION The sadness and loneliness of man is never better exemplified than in those patients who self-administer an overdose of drugs. These patients take a variety of drugs in a wide range of doses. Thus, they present to their medical attendants individual, personal, and management problems requiring a wide range of therapy. THE P ATIEKTS During the period of March ]968 to June 1973 a total of 1,137 adult patients were treated at Royal Newcastle Hospital following the selfadministration of an overdose of drugs. Of these, 118 suffered respiratory failure, according to blood gas analysis, either from the respiratory depressant effects of the drugs or other complications of the ingestion (Mills, Murree AlIen, James and Beath 1975). Paediatric patients are not included in this study. Six patients died, four of these from respiratory failure. The case histories of the six adults who died despite active treatment are presented: