European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2014
Fast Track by physician assistants shortens waiting and turnaround times of trauma patients in an emergency department.
We sought to determine whether the introduction of a separate patient flow comprising patients with simple, non-complex health issues [Fast Track (FT)] in a Dutch emergency department setting (ED), without the introduction of additional staff, and treated by a physician assistant, would have favourable effects on waiting and turnaround times without deleterious effects for patients with a higher urgency. ⋯ The introduction of FT performed by a physician assistant resulted in a significant drop in waiting time and length of stay in a Dutch ED setting. This reduction was realised without the allocation of additional staff and even reduced waiting and turnaround times for the patients with a high urgency.
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Eur J Trauma Emerg Surg · Feb 2014
Blunt bowel and mesenteric injuries detected on CT scan: who is really eligible for surgery?
There is no consensually accepted approach to the management of blunt bowel and mesenteric injuries. Surgery is required urgently in the case of bowel perforation or haemodynamic instability, but several patients can be treated non-operatively. This study aimed to identify the risk factors for surgery in an initial assessment. ⋯ In blunt abdominal trauma, the association of a bowel and/or mesenteric injury with a peritoneal effusion without solid organ injury on an initial CT scan should raise the suspicion of an injury requiring surgical treatment. Additionally, this finding should lead to a clinical discussion of the benefit of explorative laparotomy to prevent delayed surgery. However, these findings need validation by larger studies.
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Eur J Trauma Emerg Surg · Feb 2014
Elastic stable intramedullary nailing (ESIN) in the adolescent patient-perils, pearls, and pitfalls.
Elastic stable intramedullary nailing (ESIN) has become the treatment of choice for diaphyseal long-bone fractures in children. This paper reviews the complications and limitations of this method which can occur when applying this osteosynthesis to patients within the adolescent age group. ⋯ The best prophylaxis for failure of ESIN is a stable and symmetric construct with correctly sized implants. This holds even more true for the adolescent patient. Using ESIN in difficult situations such as longitudinally unstable fractures, patients with a body weight >50 kg, or away from the diaphysis should be considered and followed up carefully. If possible, these patients should be treated in specialized pediatric trauma centers.
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Eur J Trauma Emerg Surg · Feb 2014
The falling bullets: post-Libyan revolution celebratory stray bullet injuries.
To report our experience with the post-Libyan revolution celebratory stray bullet injuries by falling bullets. ⋯ Celebratory stray bullet injuries are an unusual form of injury not infrequently seen in some parts of the world. Lower limb and chest injuries especially among children are most commonly reported. Focus on prevention through education and weapon use regulations carries the best chance of reducing these injuries.