[Pathologies of the shoulder joint : Anatomy and examination techniques]

CLINICAL ISSUE

The movements and stability of the human shoulder are a complex dynamic interaction between several joints, muscles and ligaments, which on the one hand enable extensive mobility and on the other hand must provide the necessary stability. Furthermore, the complexity of the shoulder is increased by a large number of normal variants. This article aims to explain the relevant anatomical structures and the radiological examination techniques necessary to visualize them.

STANDARD RADIOLOGICAL PROCEDURES

Various modalities contribute to the examination of the shoulder. These include X‑rays, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

METHODOLOGICAL INNOVATION

It is important to use the various procedures appropriately. Especially with MRI arthrography, it is necessary to pay attention to suitable sequences and possibly additional examination positions.

PRACTICAL RECOMMENDATION

The multimodal examination of the shoulder can contribute to the diagnosis of numerous clinical pictures. Anatomical and methodological foundations are essential for this.

[Parameters influencing the preclinical application of cervical collars]

BACKGROUND

The application of cervical collars is a standard procedure in emergency care of trauma patients. It is often observed that the application of cervical collars is performed incorrectly, which may lead to reduced immobilization of the cervical spine.

OBJECTIVES

The objective of this study was to analyze the practical skills of professional emergency care providers concerning the application of cervical collars.

MATERIALS AND METHODS

Emergency care professionals (n = 104) were asked to apply a cervical collar to a training doll. Each performance step was assessed separately. Furthermore, personal and occupational data of all study participants were collected using a questionnaire.

RESULTS

The study participants included professional rescue personnel and emergency physicians. The average occupational experience of all study participants in out-of-hospital emergency care was 11.1 ± 8.9 years. Most participants had already received training on trauma care (61 %) and felt "very confident" in handling a cervical collar (84 %). The application of the cervical collar was performed correctly in 11 % of the performances. The most common error was incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and possible parameters of influence, such as working experience in emergency care or participation in trauma courses.

CONCLUSIONS

Despite pronounced subjective confidence regarding the application of cervical collars, this study shows that there are general deficits in the practical skills of applying cervical collars. Therefore, a critical assessment of the current training contents on the subject of trauma care must be demanded.

Application of Cervical Collars - An Analysis of Practical Skills of Professional Emergency Medical Care Providers

Background/Objective

The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars.

Material and Methods

Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire.

Results

The test subjects included professional rescue personnel (80.8%) and emergency physicians (12.5%). The average occupational experience of all study participants in pre-clinical emergency care was 11.1±8.9 years. Most study participants had already attended a certified training on trauma care (61%) and felt "very confident" in handling a cervical collar (84%). 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses.

Conclusion

Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded.

Improved Synthetic Route to Unsymmetrically Substituted Phosphinimino-phosphonium Salts. Crystal Structure of Tri-n-butyl- [tris(diethylamino)phosphinimino]phosphonium Chloride

The title compound was prepared from tri-n-butyl-chlorophosphonium chloride and N-tri-methylsilyl-tris(diethylamino)-phosphinimine. A low temperature X-ray crystal structure de­termination revealed PN bond lengths of 156.1(2) and 158.0(2) pm, with a PNP angle of 149.36(17)°.