Der Unfallchirurg
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Case Reports
[Multiple femur and tibia shaft fractures in the severely injured. A therapeutic challenge].
Nowadays, there is a trend towards the concept of damage control in the management of multiple trauma patients. However, the question remains whether all patients benefit from this concept. We report the primary total definitive treatment of a patient with multiple fractures of the lower extremities. Postoperative respiratory insufficiency was treated successfully by non-invasive ventilation.
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There are approximately 500,000 hospital acquired infections per year in Germany of which about 20-30% (100,000-150,000) could be prevented. Hospital acquired infections are associated with increased mortality and prolonged hospital stay. Based on approximately 4 additional days of hospital stay, nosocomial infections cause additional 2 million hospital days per year. ⋯ Experts agree that careful hand hygiene is the single most effective measure to prevent transmission of pathogens. The rate of nosocomial infections can be reduced by improved compliance of hand hygiene as demonstrated in the literature. The ''AKTION Saubere Hände'' (Clean Hands Campaign) is a national campaign by the National Reference Centre for the Surveillance of Nosocomial Infections, the Society for Quality Management in the Health System and the Action Alliance Patient Safety aimed at the sustained improvement of hand hygiene behaviour in German hospitals.
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Wrong site surgery leads to substantial individual injury to the affected patient. Therefore, organizations such as the WHO, the Joint Commission International (JCI) and the Action Alliance Patient Safety (APS) have developed procedures for avoidance of wrong site surgery. ⋯ In the DRK Clinics in Berlin the procedure for avoidance of wrong site surgery was introduced before the second recertification by the JCI for implementation of the patient safety recommendations and compliance with the four stages documented in a standard form. For successful implementation all members of staff and in particular the heads of the clinics and departments must be actively involved in order to obtain the acceptance permanently and to ensure that wrong site surgery no longer occurs in the DRK Clinics Berlin.
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In the Center for Plastic Surgery of the Trauma Hospital Berlin, between the years 2000 and 2007 we observed a total of 10 deep dermal alkali burns caused by screed. ⋯ The existing safety advice insufficiently reflects the potential risk of injury. The author demands a change in the safety warnings from "irritant" to "can cause alkali burns"; with such a change, workers may be better aware of the dangers of working with screed.
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Although burn injuries of the hand only account for approximately 2.5-3% of the total body surface area (TBSA), they are of great importance due to functional outcome, appearance and economic aspects. Initial treatment and diagnosis are important factors, which influence the further course of thermal injuries of the hand and which are found in up to 80% of treated burn injuries. Early decision-making is necessary if escharotomy or skin grafting is indicated. ⋯ In the case of full thickness thermal injuries, debridement and skin grafting should be carried out. Further interdisciplinary management involves different professional groups as surgeons and physical therapists. Fitting pressure garments and treatment of scar formation are integral parts of the successful rehabilitation of hand burns.