European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Mass-casualty terrorist incidents are a medical and organisational challenge for every hospital. The Terror and Disaster Surgical Care (TDSC®) course was developed because such incidents are associated with special injury patterns, escalating situations, and surges of casualties and haemodynamically unstable patients requiring treatment and can overwhelm the resources of hospitals. ⋯ The TDSC course complements already established courses and provides training in tactical surgical care after hospital admission. The TDSC course integrates and builds on elements of individualised trauma care such as the primary survey and the extended focused assessment with sonography in trauma (eFAST). This underlines again that it complements and does not replace other course formats. We can conclude that the presentations and the tabletop simulation game were well suited to the target group and that the participants were able to increase their knowledge of this complex subject.
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In 1994, the "danger model" argued that adaptive immune responses are driven rather by molecules released upon tissue damage than by the recognition of "strange" molecules. Thus, an alternative to the "self versus non-self recognition model" has been provided. The model, which suggests that the immune system discriminates dangerous from safe molecules, has established the basis for the future designation of damage-associated molecular patterns (DAMPs), a term that was coined by Walter G. ⋯ Thus, in this review, we focus on the recent literature dealing with the pathophysiological importance of DAMPs after traumatic injury. Since dysregulated inflammation in traumatized patients always implies disturbed resolution of inflammation, so-called model of suppressing/inhibiting inducible DAMPs (SAMPs) will be very briefly introduced. Thus, an update on this topic in the field of trauma will be provided.
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Eur J Trauma Emerg Surg · Aug 2020
Terrorist attacks: common injuries and initial surgical management.
Terrorism-related incidents and shootings that involve the use of war weapons and explosives are associated with gunshot and blast injuries. Despite the perceived threat of terrorism, these incidents and injuries are rare in Germany. For this reason, healthcare providers are unlikely to have a full understanding of the special aspects of managing these types of injuries. ⋯ Unlike damage control surgery, which is tailored to the patient's condition, tactical abbreviated surgical care (TASC) is first and foremost adapted to the overall situation. Once the patients are stabilised and all information on the situation is available, the surgical management and reconstruction of gunshot and blast injuries can follow the principles of damage control (DC) and definitive early total care (ETC). The purpose of this article is to provide an overview of the pathophysiology of gunshot and blast injuries, wound ballistics, and the approach and procedures of successful surgical management.
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Eur J Trauma Emerg Surg · Aug 2020
Uselessness of microbiological samples in acute appendicitis with frank pus: to collect or not to collect?
Current use of antimicrobial therapy is prophylactic, empirical and broad spectrum. But, the age-old practice of obtaining cultures still remain. The aim of this study was to evaluate bacterial etiology and adequacy of antibiotic prophylaxis in patients diagnosed with acute appendicitis to help determine the utility of intraoperative cultures in guiding clinical decision-making. ⋯ The etiological agents causing peritonitis due to acute appendicitis are predictable and empiric-targeted antibiotic therapy is effective in a high percentage of patients. The postoperative patient outcome may be dependent on the severity of the appendicitis more than on the results of the swab at the time of surgery. In this study, intraoperative culture was not associated with the choice of antibiotics, incidence of SSI, DPI or the length of stay.