Der Unfallchirurg
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Comparative Study
[Primary management of polytrauma. Comparison of a German and American air rescue unit].
Hospital-based helicopter services from German and American university-affiliated trauma centers were reviewed. All multitrauma patients transported via helicopter from the scene of the accident to the trauma center during a 1-year period were included. The patients were comparable regarding mechanism of injury, age, flight times, mean ISS, ISS distribution, and number of severe injuries per body region (patients with AIS > 3 for head, thorax and abdomen). ⋯ Pre-hospital care in the German system is directed on-scene by a trauma surgeon member of the flight crew, compared to a nurse/paramedic team with remote medical control in the American system. Compared to an American trauma system, the German system demonstrates improved overall outcome as measured by survivor-based TRISS Z-statistics. More favorable German Z-statistics are in part related to fewer early deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
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The TRISS method offers a standard approach for evaluating the outcome of trauma care. Based on the data of more than 150,000 patients, TRISS offers a method of calculating the individual probability of survival of trauma patients. The calculation is based on anatomical, physiological data and the age of the patient. ⋯ Recent analyses demonstrate for blunt trauma patients a sensitivity of 60.9% and a specificity of 99.2%. What does TRISS offer in comparison to other trauma scores? TRISS offers a valid approach for the screening of trauma patients regarding unexpected survival/death. Based on the largest database of trauma patients, TRISS represents a method of maintaining quality assurance for prehospital and hospital trauma patient care; it also allows comparison with international standards of trauma care.
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This paper describes experience acquired during the war against Croatia under improvised conditions at the Kutina War Hospital in the immediate vicinity of the first front lines. Over a period of almost 6 months a total of 701 soldiers and civilians, 546 of whom had been wounded by firearm missiles, were treated at the Kutina War Hospital, which has a capacity of 30-40 beds. As many as 87% of the injuries were due to mine, bomb or artillery shell shrapnel. ⋯ Amputations were performed in 10.4% of cases, including fingers and toes. Only 8 patients died during or immediately after surgery, corresponding to a very low mortality rate of 1.46%. The main prerequisites for successful treatment are a professional relationship to war surgery and its specific requirements, satisfactory technical equipment, and excellent organization of medical and non-medical services.
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Necrotizing soft tissue infections are a group of life- and limb-threatening infections. They are caused by aerobic and anaerobic bacteria occasionally in a synergistic polymicrobial combination. The literature describing necrotizing soft tissue infections is controversial and often contradictory. ⋯ Our results suggest that prompt recognition and treatment of necrotizing soft tissue infections are essential for the patient's survival. Often the full extent of the infections is underestimated initially, resulting in delayed surgical therapy. To control the rapidly spreading necrosis, early diagnosis and radical debridement of the affected tissue are essential and should be done without compromise, even if the affected limb must be amputated.
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Identification and extraction of penetrating cranial foreign bodies can cause problems in some cases. Small fragments localized deep in the orbit or cerebrum can be especially hard to detect. Severe bleeding and traumatized anatomy can make orientation difficult. ⋯ In a 21-year-old man 39 glass fragments were extracted from the left orbit. In a 36-year-old man a bone fragment was dislocated to the apex of the orbit directly under the optic nerve. Location and extraction were achieved without damage to the orbital structures with the help of the CAS system.