Scand J Trauma Resus
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Scand J Trauma Resus · Sep 2013
Factors correlating with delayed trauma center admission following traumatic brain injury.
Delayed admission to appropriate care has been shown increase mortality following traumatic brain injury (TBI). We investigated factors associated with delayed admission to a hospital with neurosurgical expertise in a cohort of TBI patients in the intensive care unit (ICU). ⋯ Delayed trauma center admission following TBI is common. Factors increasing likelihood of this were: male gender, incident at public place compared to home, low energy trauma, absence of pre-hospital physician involvement, stable blood pressure, no major extra cranial injuries, normal pupillary light reflex and severe alcohol intoxication. Focused educational efforts and access to physician consultation may help expedite access to appropriate care in TBI patients.
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Scand J Trauma Resus · Aug 2013
Comment LetterDebate on HES safety is important, but must be based on facts.
The Scandinavian Starch for Severe Sepsis / Septic Shock (6S) trial showed that hydroxyethyl starch was harmful compared to Ringer's acetate in patients with severe sepsis when used according to clinical practice and in alignment with the recommendations by the manufactures and authorities. The different interpretation by Chapell and Jacob's rely on misreading of the trial publication and is not supported by the trial data. Several hypotheses may be made regarding less harmful ways of using HES in critically ill patients, but clinicians, guideline committee members and authorities need to acknowledge that such safer ways have not yet been identified.
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Scand J Trauma Resus · Aug 2013
Case ReportsManagement of traumatic hemipelvectomy: an institutional experience on four consecutive cases.
The incidence of traumatic hemipelvectomy is rare, but it is a devastating injury. Recently, an increasing number of patients with traumatic hemipelvectomy are admitted to trauma centers alive due to improvements of the pre-hospital care. Successful management requires prompt recognition of the nature of this injury and meticulous surgical technique. We present our successful experiences on four cases of traumatic hemipelvectomy in the past nine years. ⋯ Adhering to the surgery principles of damage control including appropriate resuscitation, hemorrhage control, coagulopathy correction and multiple debridements and closure of the wounds in reasonable period of time can save the life of cases suffering from severe pelvic ring injury.
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Scand J Trauma Resus · Aug 2013
ReviewEvaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.
Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. ⋯ A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.
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Scand J Trauma Resus · Aug 2013
Clinical features and management of closed injury of the cervical trachea due to blunt trauma.
We retrospectively reviewed the presentation, diagnosis, treatment, and outcomes of patients with closed injury of the cervical trachea. We evaluated factors that improve diagnosis and treatment, reduce mortality, and avoid tracheal stenosis. ⋯ Closed injury of the cervical trachea may cause airway obstruction and is potentially life-threatening. Early diagnosis and repair to restore structure and function are important to ensure survival and avoid tracheal stenosis.