Der Unfallchirurg
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A 73-year-old male patient suffered multiple dog bites to the left hand and lower arm. The initial treatment in hospital consisted of conservative treatment with wound closure strips and bandages. For further treatment the patient was referred to the general practitioner who found a discharge of pus below the wound closure strips 2 days later. ⋯ In the subsequent arbitration procedure, the patient criticized the initial treatment and claimed that the bite wounds were not cleansed and were then closed with wound closure strips without antibiotic treatment. This was assumed to have caused extensive infection, which required surgical treatment and caused lasting complaints. The arbitration board report determined an insufficient initial clinical assessment and a faulty wound care resulting in, among other things, reduced range of movement of all fingers of the left hand.
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Blood flow restriction (BFR) limits arterial and venous blood flow and leads to blood pooling, which could increase exercise-induced training effects. Strength training at lower intensities (20-30% of maximum strength) in combination with BFR showed similar effects on muscle hypertrophy as training with 70% without BFR. Low-intensity cycling endurance training with BFR improves muscle hypertrophy and endurance performance and activates angiogenesis. ⋯ The BFR training leads to a stronger activation of the muscular metabolic reflex and thus to a relatively greater increase in exercise blood pressure, so that cardiovascular parameters should be controlled during BFR training. First meta-analyses with small numbers of healthy people and patients indicate the effectiveness of BFR training. Standardization or guidelines for clinical use are still lacking.
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In the management of trauma patients in the resuscitation room many time-pressured and critical decisions must continuously be made in complex situations. Even experienced teams frequently make errors in this context. Computer-assisted decision-making systems can predict critical situations based on patient data continuously acquired online. Based on the calculated predictions these systems can suggest the next steps in managing the patient. This review summarizes the current literature on computer-assisted decision-making in the management of trauma patients. ⋯ Computer-assisted decision-making can help to improve the management of trauma patients; however, before a ubiquitous implementation a number of technological and legislative barriers have to be overcome.
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For various reasons many patient groups are unable to perform high-intensity strength training. ⋯ The effectiveness of low-intensity BFR training is lower than for classical high-resistance training; however, it may be used as additional training method in rehabilitation programs.