Injury
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The leading cause of preventable death in the military setting is haemorrhage. Accumulating evidence has established the benefit of tranexamic acid (TXA), an antifibrinolytic, for treating traumatic haemorrhage in the hospital setting. The use of TXA in the prehospital setting, however, has not been previously described. The present study details our initial experience with a field protocol that advances TXA administration to (or as close as possible to) the point of injury. ⋯ We have shown that TXA may be successfully given in the prehospital setting without any apparent delays in evacuation. In light of recent evidence, the ability to give TXA closer to the time of wounding represents an important step towards improving the survival of trauma victims with haemorrhage, even before definitive care is available. While this may be especially relevant in austere combat environments, there is likely benefit in the civilian sector as well. The safety profile of TXA is an important consideration as prehospital personnel tended to overtreat casualties without indications for TXA per protocol. We suggest that TXA be considered a viable option for use by advanced life support providers at or near the point of injury.
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Comparative Study
Virtual morphological comparison of three intramedullary nailing systems for the treatment of proximal humeral fractures.
Proximal humerus fractures treated with intramedullary nails show good results. However, the correct anatomical reconstruction of four-part fractures is demanding especially when using intramedullary nails. We therefore compared different intramedullary nail designs for the proximal humerus in a virtual morphological manner. ⋯ Taking into account a minimum distance of 5mm between the screw head and the fracture line, osteosynthesis was possible in 54 out of 75 cases. Difficulties placing the proximal screws could be observed at the localisation of the lower lesser tubercle or/and at the sulcus intertubercularis. This morphological analysis could be the basis for choosing the most sufficient implant intra operatively or even improving the nail design.
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The aim of this study was to determine the sensitivity and specificity of a J wave on the electrocardiogram (ECG) to detect an occult cardiac injury in patients following penetrating chest trauma. ⋯ The presence of a 'J' wave on ECG signifies a significant risk of an occult cardiac injury after penetrating thoracic trauma.
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Observational Study
CT scan-detected pneumoperitoneum: An unreliable predictor of intra-abdominal injury in blunt trauma.
Free intra-peritoneal air in blunt trauma is a classic sign associated with hollow viscus injury, traditionally mandating laparotomy. In blunt abdominal trauma, the CT scan has become the diagnostic modality of choice. The increased sensitivity of CT scans may lead to detection of free intra-peritoneal air that is not clinically significant. ⋯ CT scans may detect free air that is not always clinically significant. Free fluid, seatbelt sign or radiographic signs of bowel trauma in the presence of pneumoperitoneum is highly predictive of injury and these patients should be explored. Based on the results of our study, we created an algorithm to aid in identifying those patients with intra-abdominal free air who may be observed safely.
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Stable bearing devices are often utilized by prehospital first responders in modern management of severely injured patients. It is not known whether these devices influence radiation exposure or image quality in whole-body computed tomography (WBCT). Additionally, manufacturers currently provide no specifications concerning these criteria. This investigation analyzed the influence of nine different bearing devices on these specified criteria. ⋯ In diagnostic producers using WBCT, bearing devices may be associated with relevant increases in radiation dose and can affect the image assessability. Some bearing devices are associated with no significant influence on radiation dose and reduction of image quality. Considering all results to get the best balance between image quality and radiation dose, aluminium and metal-free devices should be preferred.