European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Apr 2021
Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries?
Massive hemorrhage is a common cause of death in patients sustaining instable pelvic ring fractures. Pelvic binders have been propagated for rapid, non-invasive pelvic ring stabilization and control of severe pelvic hemorrhage. There is a recommendation to applicate a pelvic binder due to the trauma mechanism alone. However, there is little evidence to support this advice. The aim of this study was to evaluate effects of an early pelvic binder application on transfusion requirements and hospital mortality. ⋯ We were unable to identify blood-saving effects with application of a pelvic binder to patients with instable pelvic ring fractures in terms of RPBC requirements. Nevertheless, some salutary effect of prehospital pb application may be assumed. Better studies are needed to elucidate the value of this intervention.
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Eur J Trauma Emerg Surg · Apr 2021
Trends and efficacy of external emergency stabilization of pelvic ring fractures: results from the German Pelvic Trauma Registry.
External emergency stabilization (EES) of unstable pelvic fractures reduces haemorrhage and mortality. Available are non-invasive procedures (sheet sling and pelvic binder) and invasive procedures (external fixator and pelvic C-clamp). Nevertheless, there is no recommended standard as to which procedure for EES should be used. ⋯ In case of suspected unstable pelvic fracture, an EES should be performed, in case of doubt with a non-invasive EES until imaging and final diagnosis. Which method should be used depends on the individual situation and the available information about the overall injury pattern. Invasive EES are preferable for treatment according to Damage Control Orthopaedics.
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Eur J Trauma Emerg Surg · Apr 2021
Observational StudyAgreement between arterial and venous blood gases in trauma resuscitation in emergency department (AGREE).
Arterial blood gas (ABG) sampling is routinely performed in major trauma patients to assess the severity of hemorrhagic shock. Compared to venous blood gas (VBG), ABG is an additional procedure with risks of hematoma and pain. We aim to determine if pH, base deficit (BD), and lactate from VBG and ABG in trauma patients are clinically equivalent. If proven, the need for ABG and its associated risks can be eliminated. ⋯ Venous and arterial pH and BD are not within clinically acceptable limits of agreement, and ABG should be obtained for accurate acid-base status. However, venous lactate may be an acceptable substitute for arterial lactate.
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Eur J Trauma Emerg Surg · Apr 2021
Implementation of a multidisciplinary perioperative protocol in major emergency abdominal surgery.
Enhanced recovery after surgery programs is widely implemented in elective settings, however, until recently, rarely in emergency surgery. The purpose of this study was to present detailed contents and data on implementation of an emergency abdominal perioperative protocol on the basis of compliance. ⋯ We found it possible to implement a comprehensive detailed perioperative protocol in emergency abdominal surgery across multiple specialties with an overall good compliance of protocol items.
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Eur J Trauma Emerg Surg · Apr 2021
Treatment of nonunion after forearm fractures in children: a conservative approach.
Nonunions are a very rare complication after surgical treatment of displaced forearm fractures in children, but can occur in both the radius or ulna. The aim of this study is to evaluate predisposing factors for non-unions and to discuss treatment options. ⋯ Open reduction and technical problems seem to be influencing factors. A conservative approach can be adopted in asymptomatic patients, otherwise an operative management, constituting plate osteosynthesis with or without bone grafting, should be performed.