Injury
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Tourniquet application is the standard method for the control of severe trauma haemorrhage. However, it may result in severe ischaemic injuries when used for a long time. In this study, we developed a modified ethyl-2-cyanoacrylate-based aerosol (ECA) aerosol spray and determined its efficacy for short-time control of bleeding of large wounds in pigs when used in combination with tourniquet application. ⋯ The ECA spray achieves haemostasis within a very short time when it is used in combination with tourniquet application in a large wound model with an arterial injury. It may effectively prevent the wound from bleeding without the need for any long-term pressure bandage to wrap the wound, and it is easy to be disposed in debridement. Therefore, it may serve as an optimal choice for the first aid of large wounds with an arterial injury.
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Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.
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Randomized Controlled Trial
Gender differences in outcome in patients with hypotension and severe traumatic brain injury.
Animal studies have identified hormonal influences on responses to injury and recovery, creating a potential gender effect on outcome. Progesterone and oestrogen are thought to afford protection in the immediate post-injury period, suggesting females have an advantage, although there has been limited evidence of this in human outcome studies. ⋯ The study provides no evidence that females fare better than males following severe TBI, suggesting rather that females may fare worse.
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It is important to avoid or minimise allogeneic blood transfusion, because of possible alloimmunisation or disease transmission. In burn cases these risks are high, and predonated autologous transfusion is not practical. Perioperative haemodilutional autologous blood transfusion is considered applicable in burn surgery. This study evaluates the effectiveness of the technique in the treatment of burns.
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A damage control (DC) approach was developed to improve survival in severely injured trauma patients. The role of DC in acute surgery (AS) patients who are critically ill, as a result of sepsis or overwhelming haemorrhage continues to evolve. The goal of this study was to assess morbidity and mortality of AS patients who underwent DC, and to compare observed and predicted morbidity and mortality as calculated from APACHE II and physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scores. ⋯ Although the morbidity and mortality of AS patients undergoing DC is high, the application of DC principles in this group may reduce mortality compared to that predicted by POSSUM or APACHE II. In order to adequately demonstrate this contention, large, multi-institutional studies of DC in AS patients need to be performed. The POSSUM score appears to accurately estimate the high morbidity in general surgery DC patients, and supports the importance of team management of these complex patients by acute care surgery specialists.