European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. ⋯ Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.
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Eur J Trauma Emerg Surg · Apr 2017
Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability.
Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions. ⋯ Minimized approaches allow sufficient stabilization of severe dislocated rib fractures without extensive dissection or division of the important muscles. Keeping the arm and, thus, the scapula mobile is very important for providing the largest reachable surface of the rib cage through each approach.
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Eur J Trauma Emerg Surg · Apr 2017
Case ReportsThe role of a video-assisted thoracic approach for rib fixation.
Rib fixation remains a contentious issue in the current practice of orthopaedic, trauma and thoracic surgeons. Whilst rib fractures are undoubtedly associated with high levels of morbidity and mortality, the optimal surgical approach has not yet been fully elucidated in prospective trials and the volume of procedures performed remains low. ⋯ We discuss the involvement of thoracic surgeons, early assessment of the thoracic cavity with video assistance and optimal peri-operative management with particular reference to cases which demonstrate recent changes in our practice.
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Eur J Trauma Emerg Surg · Apr 2017
Predictors of retained hemothorax after trauma and impact on patient outcomes.
Hemo/pneumothoraces are a common result of thoracic injury. Some of these injuries will be complicated by retained hemothorax (RH), which has previously been shown to be associated with longer hospitalizations. It has been proposed that early versus delayed intervention with video-assisted thoracoscopic surgery can reduce the duration of mechanical ventilation, hospital and ICU LOS, and costs in patients with RH. However, little is known regarding the effect of RH on these outcomes relative to patients with uncomplicated hemo/pneumothoraces. The aim of our study was to characterize factors present on admission that may be associated with RH and assess the impact of RH on outcomes. ⋯ Our study suggests patients requiring ventilator support on admission and those with bilateral injuries are at increased risk of developing RH. Early identification of patients at risk for RH may allow for earlier intervention and potential benefits to the patient.
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Eur J Trauma Emerg Surg · Apr 2017
Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres.
Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres. ⋯ There is variation in the local infrastructure, logistics and management of trauma haemorrhage and coagulopathy across German trauma centres. More than one-third of the respondents declare they do not consistently follow a treatment algorithm. NOACs are considered as an increasing problem in acute trauma care.