Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2009
EditorialManagement of burn injuries--recent developments in resuscitation, infection control and outcomes research.
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis. ⋯ Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.
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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 ReportsSubmersion, accidental hypothermia and cardiac arrest, mechanical chest compressions as a bridge to final treatment: a case report.
Three young men were trapped in a car at the bottom of a canal at two meters depth, after losing control of their vehicle. They were brought up by rescue divers and found in cardiac arrest. One of three patients had return of spontaneous circulation (ROSC), at 47 min after the accident. ⋯ At follow-up six months later, he had a complete cerebral recovery but still had myoclonic twitches in the lower extremities. A mechanical device facilitates chest compressions during transportation and may be beneficial as a bridge to final treatment in the hospital. We recommend that comatose patients after submersion, accidental hypothermia and cardiac arrest are treated with mild hypothermia for 12-24 h.
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Scand J Trauma Resus · Dec 2008
Mechanical ventilation in the ICU--is there a gap between the time available and time used for nurse-led weaning?
Mechanical ventilation (MV) is a key component in the care of critically ill and injured patients. Weaning from MV constitutes a major challenge in intensive care units (ICUs). Any delay in weaning may increase the number of complications and leads to greater expense. Nurse-led, protocol-directed weaning has become popular, but it remains underused. The aim of this study was to identify and quantify discrepancies between the time available for weaning and time actually used for weaning. Further, we also wished to analyse patient and systemic factors associated with weaning activity. ⋯ Our study identified a significant gap between the time available and time actually used for weaning. While various patient and systemic factors were linked to weaning activity, the most important factor in our study was whether the intensive care nurses made use of the time available for weaning.