Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2015
Review Case ReportsTension gastrothorax: acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children.
Tension gastrothorax in children is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intra-thoracic stomach herniated through a diaphragmatic defect is massively distended by trapped air and/or fluid causing mediastinal displacement. ⋯ We present a child with tension gastrothorax and a literature review of this phenomenon. Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach before laparotomy with reduction of herniated viscera and repair of the diaphragmatic defect.
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Scand J Trauma Resus · Jan 2015
ReviewImplementing a template for major incident reporting: experiences from the first year.
Major incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. ⋯ The template is accompanied by an open access webpage ( www.majorincidentreporting.org ) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports.
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Scand J Trauma Resus · Jan 2015
ReviewDoes turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration? - A systematic review.
Airway protection and spinal precautions are competing concerns in the treatment of unconscious trauma patients. The placement of such patients in a lateral position may facilitate the acquisition of an adequate airway. However, trauma dogma dictates that patients should be transported in the supine position to minimize spinal movement. In this systematic review, we sought to answer the following question: Given an existing spinal injury, will changing a patient's position from supine to lateral increase the risk of neurological deterioration? ⋯ We identified no clinical studies demonstrating that rotating trauma patients from the supine position to a lateral position affects mortality or causes neurological deterioration. However, in various cadaver models, this type of rotation did produce statistically significant displacements of the injured spine. The clinical significance of these cadaver-based observations remains unclear. The present evidence for harm in rotating trauma patients from the supine position to a lateral position, including the logroll maneuver, is inconclusive.
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Scand J Trauma Resus · Jan 2015
Review Meta AnalysisIs the supine position associated with loss of airway patency in unconscious trauma patients? A systematic review and meta-analysis.
Airway compromise is a leading cause of death in unconscious trauma patients. Although endotracheal intubation is regarded as the gold standard treatment, most prehospital providers are not trained to perform ETI in such patients. Therefore, various lateral positions are advocated for unconscious patients, but their use remains controversial in trauma patients. We conducted a systematic review to investigate whether the supine position is associated with loss of airway patency compared to the lateral position. ⋯ Although concerns other than airway patency may influence how a trauma patient is positioned, our systematic review provides evidence supporting the long held recommendation that unconscious trauma patients should be placed in a lateral position.
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Scand J Trauma Resus · Jan 2015
ReviewTransfusion therapy in paediatric trauma patients: a review of the literature.
Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT). Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. ⋯ MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising. Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted.