Ulus Travma Acil Cer
-
Ulus Travma Acil Cer · Jan 2010
Randomized Controlled TrialSingle or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study.
The number of distal locking screws may have an effect on union, complication rates and operation time. The purpose of this study was to determine the effect of one or two distal locking screws in unreamed intramedullary nailing of closed or grade 1 open, simple or wedge tibial shaft fractures on the incidence of malunion, delayed union, non-union, and screw failure. ⋯ For non-complex, closed or grade 1 open tibial shaft fractures, locking of an intramedullary nail with a single distal screw is safe, and may help to decrease operation time and radiation exposure.
-
Informed consent is a prerequisite for the ethical and legal validity of the emergency intervention in emergency medicine, since it protects the fiduciary relationship between the physician and patient; the principle of honesty that grounds this relationship; the principle of autonomy that necessitates right of self-determination; and the principle of respect for persons. Informed consent in emergency medicine, which is supposed to include the nature, benefits and risks of emergency medical intervention, differentiates with respect to definite groups of patients: (1) conscious patients, (2) unconscious patients, and (3) children and mature minors. ⋯ In addition to the exceptions of life-saving interventions, when a patient can not decide for herself/himself, intervention of the physician in the best interest of the patient or children is based on the "therapeutic privilege" of the physician. As an ethically defensible right, since therapeutic privilege may open a door to hard paternalistic approaches, in those situations, emergency physicians should be cautious not to violate a patient's autonomy.
-
Ulus Travma Acil Cer · Jan 2010
Does Ochsner-Sherren regimen still hold true in the management of appendicular mass?
Although proposed as far back as 1901, conservative management for appendicular mass is still widely practiced. With a few recent series outlining the advantages of early appendicectomy for appendicular mass, we tried to investigate the feasibility of such an approach in this retrospective study. ⋯ Low morbidity, reduced hospital stay, low cost, and patient compliance favor early operative management for appendicular mass, and it also avoids the possibility of missing entities like intestinal/peritoneal tuberculosis, which have similar presentations and are especially common in a country like India.
-
Ulus Travma Acil Cer · Jan 2010
Mannheim Peritonitis Index and APACHE II--prediction of outcome in patients with peritonitis.
Early prognostic evaluation of patients with peritonitis is desirable to select high-risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. This study attempts to evaluate the use of scoring systems such as Acute Physiological and Chronic Health Evaluation score (APACHE II) and Mannheim Peritonitis Index (MPI) in patients with peritonitis. ⋯ Both scoring systems are accurate in predicting mortality; however, the APACHE II has definitive advantages and is therefore more useful.
-
Ulus Travma Acil Cer · Jan 2010
Case ReportsIsolated jejunal perforation following blunt abdominal trauma.
Isolated jejunal perforation caused by blunt abdominal trauma is uncommon and most often seen after motor vehicle accidents. We present a case of "blowout" perforation of the jejunum in a young male who was admitted to our hospital with intense abdominal pain following a physical assault. ⋯ The exploratory laparotomy that followed revealed only a 3 cm-long perforation of the jejunum, 20 cm from the ligament of Treitz. Although our experience as a trauma center is limited, clinical suspicion and timely exploration in this case led to prompt surgical intervention and a successful outcome.