Eur J Trauma Emerg S
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Old age is considered a risk factor; however, its effect on the prognosis of injured elderly patients remains uncertain. ⋯ Old age has no influence on final outcome of E multi trauma patients; hence, the therapeutic approach of these patients should be the same in Y.
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Eur J Trauma Emerg S · Jun 2008
Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review.
We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal complaints. ⋯ Contusion of the gallbladder allows conservative treatment, but in case of a rupture, surgery will be necessary. Accompanying bile duct injuries can be treated by endoscopic stenting. If active arterial bleeding is present, selective embolization can be performed.
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Necrotizing fasciitis (NF) describes a life threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. Various synonyms for this type of infection are used, often due to the difficult diagnosis. Necrotizing fasciits of the extremities is found after simple skin lacerations and often in rural, farming or garden setting environments. ⋯ In fulminated cases early amputations, maximal intensive care treatment of the septic patient are required, where all means are warranted to save the patients life. As a consequence, early clinical diagnoses with thorough surgical debridement of the infected liquid necrotic fascia as well as correct antibiotic treatment are needed. Secondary plastic reconstruction of the soft tissue defects will generally be required.
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Eur J Trauma Emerg S · Jun 2008
Percutaneous Dilational Tracheostomy in a Community Intensive Care Unit.
Percutaneous dilational tracheostomy (PDT) is increasingly being used to replace traditional surgical tracheostomy (ST) in the management of critically ill patients. There is considerable controversy regarding the safety of this procedure in the hands of non-surgeons, and most data so far have come from large tertiary care centres. We report our experience and safety data in the implementation of a PDT program for critically ill patients in a teaching community hospital in an attempt to demonstrate that this procedure can be performed safely outside of an academic ICU. ⋯ Percutaneous dilational tracheostomy appears to be at least as safe as traditional ST, and may have advantages with respect to timeliness and minimization of patient transport. The complication rate seen in our program is similar to that seen in other PDT series.