European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Knife-inflicted, deeply penetrating head and neck trauma is an uncommon life-threatening injury and a challenging problem. An examination of the neurovascular and systemic physical status is a first requirement and the decision as to which approach to adopt for the removal of the blade is of critical importance. Here we report a rare case of a pre-auricular stab wound with the knife blade deeply lodged in the extracranial infratemporal fossa. ⋯ The other neurological and systemic physical evaluations were normal. Simple withdrawal of the blade in the operating room did not cause serious neurovascular injury. Here we discuss and compare the expanded exposure of anatomical structures for blade removal and simple withdrawal in similar injuries.
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Biphasic-flow induced ventilation (BiFIV) is a variable time-cycled tracheal gas insufflation mode, using a specific multiluminal endotracheal tube. Some recent studies have reported efficiency of this new ventilatory mode in experimental in vitro and in vivo settings. We hypothesized that this ventilatory mode could be able to deliver simultaneous efficient ventilation for several animals, using a single ventilator prototype. ⋯ Oxygenation was as efficient for each three animals ventilated under BiFIV, using a single ventilator device, as under conventional ventilation, using three separate ventilators (PaO2 = 112+/-17 mmHg under conventional ventilation versus 115+/-16 mmHg under BiFIV). In conclusion, variable time-cycled tracheal gas insufflation may allow an efficient multiple ventilation on several animals, using a single multiple output ventilatory device, in a normal lung animal model. If validated on subsequent pathological models, it could thus be interesting in laboratory and/or mass casualty situations.
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Editorial Comment Comparative Study
Towards an international triage scale.
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A retrospective study was undertaken to compare the management of head injured patients in a short stay ward (SSW) with their management in other departments in the same hospital, where there is no neurosurgery department. Head injured patients were admitted to the general surgery department until November 1998, when the SSW was inaugurated. The following data were collected for all head injured patients admitted between 1997 and 1999: age, gender, diagnosis, outcome categories and length of stay. ⋯ The length of stay was longer in general surgery (3.5 +/- 3.9 days) and neurology departments (9.6 +/- 19.1 days) than in the SSW (1.4 +/- 0.8 days) and paediatrics department (1.5 +/- 1.5 days). Thirteen patients in the SSW required admission to another department in the hospital and only one was transferred to the neurosurgery department in another hospital. The results support the view that SSWs are suitable in the management of head injured patients.