Scand J Trauma Resus
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Scand J Trauma Resus · Oct 2011
ReviewEsophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours.
Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. ⋯ Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.
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Scand J Trauma Resus · Oct 2011
Thrombelastography and biomarker profiles in acute coagulopathy of trauma: a prospective study.
Severe injury induces an acute coagulopathy associated with increased mortality. This study compared the Thrombelastography (TEG) and biomarker profiles upon admission in trauma patients. ⋯ Trauma patients displayed different coagulopathies by TEG and variables independently associated with clot strength changed with ISS. In the highest ISS group, adrenaline and sCD40L were independently negatively associated with clot strength indicating that these may contribute to acute coagulopathy.
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Scand J Trauma Resus · Oct 2011
Case ReportsSurvival following a vertical free fall from 300 feet: the crucial role of body position to impact surface.
We report the case of a 28-year old rock climber who survived an "unsurvivable" injury consisting of a vertical free fall from 300 feet onto a solid rock surface. The trauma mechanism and injury kinetics are analyzed, with a particular focus on the relevance of body positioning to ground surface at the time of impact. The role of early patient transfer to a level 1 trauma center, and "damage control" management protocols for avoiding delayed morbidity and mortality in this critically injured patient are discussed.
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Scand J Trauma Resus · Oct 2011
Editorial CommentTrauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival.
Trauma is a major--and increasing--cause of death, especially in low- and middle income countries. In all countries rural areas are especially hard hit, and the distribution of physicians is skewed towards cities. ⋯ Researchers in these countries need support and collaboration from their peers in industrialized countries. This partnership will be of mutual benefice.
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Scand J Trauma Resus · Oct 2011
Comparative StudyLaypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.
Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. ⋯ Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.