Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2009
Clopidogrel and Proximal Femoral Fractures: Does Timing of Surgery Affect Blood Loss and Length of Admission? A Preliminary Study Prior to Multicenter Trial.
Clopidogrel is a potent oral antiplatelet agent that is commonly prescribed to patients with cardiovascular disease. Patients presenting with proximal femoral fractures often have cardiovascular comorbidity, with many taking clopidogrel on admission. Scientific literature reports increased surgical bleeding in patients receiving clopidogrel, though not specifically hip surgery. This study looked at whether patients who had a seven-day delay prior to operative treatment had less bleeding than those who did not, and looked at the differences in length of admission between the two groups. ⋯ Patients should be considered for early operation provided there are no additional bleeding risk factors, as although postoperative hemoglobin is lower, mortality and complication rates are similar, and length of admission is shorter.
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Eur J Trauma Emerg S · Jun 2009
Major Incident Hospital: Development of a Permanent Facility for Management of Incident Casualties.
Preparation is essential to cope with the challenge of providing optimal care when there is a sudden, unexpected surge of casualties due to a disaster or major incident. By definition, the requirements of such cases exceed the standard care facilities of hospitals in qualitative or quantitative respects and interfere with the care of regular patients. To meet the growing demands to be prepared for disasters, a permanent facility to provide structured, prepared relief in such situations was developed. ⋯ The MIH in Utrecht (Netherlands) is a globally unique facility that can provide immediate emergency care for multiple casualties under exceptional circumstances. Resulting from the cooperation between a large academic medical institution, a trauma center, a military hospital and the NVIC, the MIH offers not only a good and complete infrastructure but also the expertise required to provide large-scale emergency care during disasters and major incidents.
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Eur J Trauma Emerg S · Jun 2009
Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice.
In an aging population, anticoagulation in patients with musculoskeletal injuries is increasingly prevalent. The North American literature indicates an absence of consensus concerning the most appropriate management for this group. We aim to test the hypothesis that there is a lack of consensus in the UK regarding the perioperative management of patients with hip fractures on long-term warfarin therapy. ⋯ Hip fracture in the presence of long-term warfarin use is associated with significantly increased morbidity. This problem is likely to increase. Our results demonstrate variation in approach throughout the UK with regard to warfarin reversal and the acceptable INR at which to operate in this group of patients. We propose that low-dose vitamin K is considered more widely as a safe and effective method of warfarin reversal in this group.
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Eur J Trauma Emerg S · Jun 2009
A Lethal Case of Fat Embolism Syndrome in a Nine-Year-Old Child: Options for Prevention.
We report a lethal case of fat embolism syndrome in a nine-year-old child after a direct blunt trauma leading to a pelvic fracture. On the second day, signs of bowel perforation and septic shock led to an acute aggravation of the pulmonary symptoms, cardiac arrest and death. Fat embolism is seldom thought to occur in pediatric trauma patients; however, this case illustrates it can lead to disastrous sequela. Since there is no specific treatment for it, prevention by early fracture stabilization is the only option.
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Eur J Trauma Emerg S · Jun 2009
A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria.
Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism. ⋯ Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.