Injury
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The aim of prehospital treatment of head injuries and severe multiple injuries is to prevent additional cerebral damage. When accidents occur in remote mountain areas, time is lost covering the distance to the nearest cabin or village where the rescue team can be called by telephone. Rapid transport of a trained physician to the patient can save precious time and allows prompt control of respiration and circulation at the scene of the accident. ⋯ At 6 months after the accident, a normal neurological state was registered in 44 of the 55 survivors (88 per cent), whereas mild neurological deficiencies were noted in six patients (12 per cent). No persistent coma or vegetative state was seen. This experience suggests that fast rescue by a helicopter equipped with a winch and with an experienced emergency physician on board in an effective way of preventing secondary cerebral damage after accidents in remote mountain areas.
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In all, 160 serious pedestrian accidents (ISS > 15 or death), were recorded during a 12-month prospective study of all trauma in a population of 3.2 million. Of these, 35 died at scene, 125 arrived at hospital alive and 68 (54 per cent) subsequently died. There were 35 (22 per cent) children, and 62 per cent (39) were more than 60 years of age. ⋯ The Revised Trauma Score and APACHE II score showed significant differences between those who lived and died. TRISS analysis revealed that 32 per cent of deaths and 12 per cent of survivors were unexpected. ATLS treatment protocols should be instituted for prehospital care and in all accident and emergency departments (A&E).
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The treatment of Colles' fractures in the elderly comprises a heavy workload for both accident and orthopaedic departments. The initial management has important clinical and financial implications for patient and hospital. ⋯ The choice of anaesthetic technique is therefore most important. In our experience, intravenous sedation with midazolam (a water soluble benzodiazepine) has proven to be safe and effective in providing good conditions for anatomical reduction of Colles' fractures on an outpatient basis.