Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2009
Case ReportsManagement of a massive thoracoabdominal impalement: a case report.
A 26 year old male was impaled through his chest and upper abdomen with an iron angle, one and half meter long and five centimeters thick. The iron angle entered the chest, through the epigastrium and exited posteriorly just inferior to the angle of left scapula. The patient was transported to hospital with the iron angle in situ. ⋯ An unconventional position for intubation allowed a successful airway management. Paucity of time prevented us from gauging the nature and extent of injury. The challenges posed by massive impalement could be successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.
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Scand J Trauma Resus · Jan 2009
EditorialPersonal experience with whole-body, low-dosage, digital X-ray scanning (LODOX-Statscan) in trauma.
Lodox-Statscan is a whole-body, skeletal and soft-tissue, low-dose X-ray scanner Anterior-posterior and lateral thoraco-abdominal studies are obtained in 3-5 minutes with only about one-third of the radiation required for conventional radiography. Since its approval by the Food and Drug Administration (FDA) in the USA, several trauma centers have incorporated this technology into their Advanced Trauma Life Support protocols. This review provides a brief overview of the system, and describes the authors' own experience with the system. ⋯ The intention of our review has been to sensitize the readership that such alternative devices exist. The key message is that low dosage full body radiography may be an alternative to conventional resuscitation room radiography which is usually a prelude to CT scanning (ATLS algorithm). The combination of both is radiation intensive and therefore we consider any reduction of radiation a success. But only the future will show whether LS will survive in the face of low-dose radiation CT scanners and magnetic resonance imaging devices that may eventually completely replace conventional radiography.
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Scand J Trauma Resus · Jan 2009
Critical care in the emergency department: an assessment of the length of stay and invasive procedures performed on critically ill ED patients.
Critically ill patients commonly present to the ED and require aggressive resuscitation. Patient transfer to an ICU environment in an expedient manner is considered optimal care. However, this patient population may remain in the ED for prolonged periods of time. The goal of this study is to describe the ED length of stay, and the invasive procedures performed in critically ill ED patients. ⋯ Critically ill patients are managed in the emergency department for a significant length of time. Although the majority of airway intervention occurs in the prehospital setting and ED, relatively few patients undergo invasive procedures while in the emergency department.
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Scand J Trauma Resus · Jan 2009
Case ReportsNo fate but what we make: a case of full recovery after out-of-hospital cardiac arrest.
An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on reevaluation, the victim had pulse and spontaneous breathing. ⋯ Twenty four months later, he remains asymptomatic. In this case, the immediate call for the Advanced Life Support team, prompt basic life support and the successful defibrillation, altogether, contributed for the full recovery. Furthermore, the swiftness in the detection and treatment of the acute reversible cause (myocardial ischemia in this case) was crucial for long-term prognosis.
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Therapeutic hypothermia (TH) in unconscious survivors of out-of-hospital cardiac arrest (OHCA) is now a well-documented part of post-resuscitation care. Implementation of TH into daily clinical practice has been far more successful in the Scandinavian countries than in the rest of the world. Still, many questions remain. One of them is whether prehospital cooling will result in better outcomes.