J Trauma
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In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. ⋯ The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.
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In this article, we present our experience of group lightning injury. Individual injuries are most common after single strikes. ⋯ Although injured under the same circumstances, these patients presented with a wide range of symptoms and signs. We also describe a characteristic burn pattern, the "tip-toe sign."
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The generation of iron-dependent toxic oxygen radicals during the initial resuscitation from hemorrhagic shock was shown to be a relevant factor for the initiation of the inflammatory cascade. Therefore, this experimental study was designed to evaluate the effects of a deferoxamine-conjugated hydroxyethyl-starch solution (HES-DFO) on oxygen radical induced injury and microcirculatory alterations in the rat liver compared with resuscitation with regular hydroxyethyl-starch, lactated Ringer's solution (RL), or a gelatin-based solution. ⋯ The results suggest that HES-DFO effectively reduces oxygen radical formation during the initial resuscitation period, thus, attenuating pathologically enhanced leukocyte adhesion and improving hepatic microcirculation.
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Trauma care delivery in Canada, even in major trauma centers, usually devolves to the most involved service. For patients with multisystem injuries, this is not always optimal and aspects of care outside the domain of the primary service are apt to be overlooked. Trauma care is necessarily multidisciplinary, and to be optimal, appropriate integration of the care process and prioritization are required. The purpose of this study was to examine the impact on care in a busy provincial trauma center, after the introduction of a trauma program with a clinical trauma service, revised trauma protocols, and a dedicated trauma unit. ⋯ Trauma care improvement can be achieved by a multidisciplinary team focusing on the process of care, developing a dedicated trauma service to manage the more seriously injured patients, collecting them onto a single unit, and initiating program management.
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The optimal method of evaluating blunt abdominal trauma remains controversial. A combination of a sensitive screening test, diagnostic peritoneal lavage (DPL), and a specific test, abdominal computed tomography (CT), may be a safe, efficient approach to adult blunt abdominal trauma. ⋯ Screening DPL, followed by abdominal CT if positive, is a safe, efficient method of evaluating adult blunt abdominal trauma that reduces the time required to evaluate the abdomen, does not result in increased nontherapeutic celiotomies, results in fewer missed injuries, and reduces the overall use of abdominal CT.