Canadian journal of surgery. Journal canadien de chirurgie
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The ability to transfuse blood (a form of tissue transplantation) with relatively few immediate and long-term complications has led to increased survival in victims of injury who require massive amounts of blood. The primary deficit in hypovolemic shock secondary to trauma is in oxygen transport to the hypoperfused tissues; therefore, blood transfusion has an essential role in therapy during resuscitation and definitive treatment. ⋯ With improved screening techniques and heightened donor awareness, the risk of disease transmission is less than 2%. Until synthetic oxygen-carrying solutions are available, the transfusion of red blood cells, when appropriately indicated, will remain an important component in the resuscitation of the trauma patient.
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The clinical value of total serum amylase (TSA) levels measured after blunt trauma remains controversial. To test the utility of this measurement, the authors surveyed the routine admission TSA levels of 4316 adults who were victims of blunt trauma. Most patients (58.2%) had been injured in motor vehicle accidents, and all were admitted directly from the accident scene. ⋯ There was no relation between the anatomic grade of pancreatic injury and the TSA level. Acute hyperamylasemia after blunt trauma appears to be a poor predictor of pancreatic and hollow-viscus injuries. Therefore, urgent TSA determinations should not influence the clinical and radiologic evaluation of the blunt trauma victim.
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The goal of the Maintenance of Competence (MOCOMP) Pilot Project is to develop a comprehensive CME strategy that will motivate specialists to continuously update their clinical practice. In its 1st year the pilot program has taken several significant steps. ⋯ A diary has been implemented for specialists to record CME activities and their potential impact on practice. The MOCOMP Program is the first attempt to motivate self-directed continuing medical education (CME) through the use of a diary and the first attempt to use this instrument to encourage critical appraisal of personal CME habits.