Ugeskrift for laeger
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Ugeskrift for laeger · May 2011
Review[Etomidate can not be recommended to patients with septic shock].
Due to a low cardiovascular complication rate even in patients with shock, etomidate is often used for intubation. Etomidate inhibits the steroid synthesis. A single bolus injection of etomidate has so far been considered to be safe. However, new investigations have shown that even a single bolus dose of etomidate inhibits the steroid synthesis and is associated with increased mortality in patients with septic shock.
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Ugeskrift for laeger · May 2011
Review[Remifentanil may in certain cases be used as an alternative to epidural analgesia for parturients].
Epidural analgesia remains the gold standard during labour, but is contraindicated in several clinical settings due to increased risk of serious complications. There are few effective alternatives to epidural analgesia. ⋯ Remifentanil appears to have a potential as labour analgesic. Careful monitoring of the parturient and the newborn is advised.
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Ugeskrift for laeger · May 2011
[Prehospital treatment of severely injured patients with focus on damage control-surgery].
The majority of patients undergoing damage control surgery initially receive prehospital treatment. Bleeding causes 40% of trauma deaths, half of which happen in the prehospital setting. Future research and improved treatment before hospital admission should focus on control of the bleeding, avoidance of hypothermia, minimising the time to definitive surgery, and a restrictive and goal directed therapy with regard to the intake of fluids. On occasion, lifesaving procedures could be performed during transport to the hospital.
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Damage control orthopedics (DCO) is a concept for treatment of fractures in severely injured patients. The fractures are stabilized with external fixators instead of primary definitive osteosynthesis, known as early total care (ETC). The purpose of DCO is to minimize time of surgery and bleeding and thereby minimize the "second hit". Not all patients require DCO, patients with stable vital functions can safely be treated with primary definitive osteosynthesis, DCO is, however, a safe method that can be used, when shorter time of surgery is desirable or a systemic immune response is imminent.
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Ugeskrift for laeger · May 2011
Case Reports[Resuscitation and abdominal surgical aspects of damage control surgery].
In multitrauma patients continuous bleeding is one of the major killers. Coagulation defects have been shown to be a primary event and to occur very early in multitrauma patients (acute traumatic coagulopathy). It is enhanced by acidosis, hypothermia and further coagulation disorders in the "bloody vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage control surgery).