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This chapter presents the key facts, clinical presentation, diagnostic testing, treatment of procedures, and prognosis of shoulder and elbow emergencies such as glenohumeral dislocations, scapular fractures, clavicle fractures, sternoclavicular (SC) injuries, acromioclavicular injuries, and proximal humerus fractures. Failure to obtain a lateral projection can result in missing a posterior dislocation in up to 50% of cases. Reductions performed with intra-articular anesthetic injections have been safely performed with equivalent success rates, similar patient comfort, shorter ED length of stays, and lower complication rates. Electromyogram (EMG) testing can be performed at a later date to evaluate suspected nerve injuries. Presence of a posterior SC dislocation should prompt evaluation for associated injuries to the trachea, esophagus, and great vessels, which are in close proximity to the SC joint. Plain radiographs are the preferred test for evaluation of suspected humeral shaft fractures.
To learn what types of torture exist and screen patients who are potential survivors of torture
To understand the acute and chronic effects of torture on patients
To learn how to treat, document, and refer survivors of torture
‘Medicine and torture both hold a topographical affinity for each other in the sense that both reside and ‘colonise’ the private space of the sentient body of a human being: one to save a life and the other to destroy it.’
– Merlau-Ponty (Vinar, 2005)
The recent atrocities at Abu Ghraib have once again focused attention on victims of torture. Photographs from this prison site vividly illustrate the immediate physical damage sustained by victims of torture; however, these pictures do not fully illustrate the extensive long-term medical and psychological injuries sustained by these individuals. Furthermore, most victims of torture do not present in such a dramatic fashion. The United Nations (UN) High Commission of Refugees estimates that worldwide there were 9.7 million victims of torture in 2004 and Amnesty International estimates that 104 countries still practice some form of torture today. As victims of torture often flee their homeland after the abuse, physicians worldwide should be familiar with the medical needs of torture victims. This chapter will familiarize physicians with the current definitions of torture and types of torture used today as well as common medical and psychological concerns of these individuals.
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