Maxillofacial trauma is common and may lead to haemorrhage that is associated with actual or impending airway compromise. This study briefly discusses the aetiology of midfacial haemorrhage and describes a simple effective technique of midface splintage for haemorrhage control, which may be applied in the prehospital and emergency environments. This technique has been used successfully by the London Helicopter Emergency Medical Service.

A 63 year old white man presented to the accident and emergency department with a 24 hour history of gradual onset of mild weakness of his left upper limb, which progressed to involve his left lower limb. There was no history of any other CNS symptoms. He also stated that the paresis varied with posturebeing worse on standing and sitting, while it was relieved by lying down; it was also associated with a noticeably diminished shortterm memory over the past few weeks. Clinical examination confirmed a mild left hemiparesis (grade 4/5), with brisk reflexes and an "equivocal" plantar response on the left. The rest of the examination was unremarkable: he was normotensive, no carotid bruits were auscultated and the fundi were normal. Haematological and biochemical investigations were normal.

Objective-To compare functional outcome in patients with acute grade 1 or 2 (mild to moderate) lateral ankle sprains randomised to treatment with or without a double tubigrip bandage (DTG). Methods-400 patients presenting to the accident and emergency (A&E) departments of a teaching hospital and a district general hospital and diagnosed with grade 1 or 2 lateral ankle sprains were randomised to treatment with or without a DTG bandage. A standardised telephone questionnaire was performed one week after presentation. The main outcome measures were: number of days until walking unaided, number of days oV work, whether the injury kept the patient awake at night, whether analgesia was taken. Results-197 of 400 patients completed follow up. There were no significant diVerences in terms of age, sex and occupation between the treatment groups. There were no significant diVerences between those who did and those who did not complete follow up. There was no significant diVerence between the treatment groups for number of days until walking unaided (95% CI −0.21 to 0.88 days), number of days oV work (95% CI −0.70 to 1.02 days) or whether the injury kept the patient awake at night (95% CI −10 to 17%). There was a significant diVerence between the groups in the use of analgesia (95% CI 10 to 36%); the diVerence seemed to be that patients treated with DTG required significantly more analgesia. Conclusions-Treatment of grade 1 and 2 ankle sprins with DTG does not seem to lead to a shorter time to functional recovery and may increase the requirement for analgesia. (Emerg Med J 2001;18:46-50) Keywords: ankle sprain; compression bandage; double Tubigrip Lateral ankle sprains account for up to 3% to 5% of all accident and emergency (A&E) attendances.

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