European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Pancreatic enzymes are routinely measured during reception of trauma patients to assess for pancreatic injury despite conflicting evidence on their utility. The aim of this study was to investigate the utility of routine initial serum lipase measurement for the diagnosis of acute pancreatic trauma. ⋯ A normal serum lipase result can be a useful adjunct to exclude pancreatic injury. A positive lipase result, regardless of the cut-off used, was not reliably associated with pancreatic trauma, and should not be used to guide further assessment.
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Eur J Trauma Emerg Surg · Jun 2014
Epidemiology of pertrochanteric fractures: our institutional experience.
Hip fractures, a common manifestation of fragility fractures, represent a major cause of morbidity and mortality in the elderly population and may have devastating consequences to the patient, their family, and society thereafter. We attempted to define the epidemiology of pertrochanteric fractures treated at a large university teaching hospital in the UK and compared our findings with the national and international literature. ⋯ The incidence of pertrochanteric fractures remained unchanged over the last 5 years. The relative incidence of pertrochanteric fractures is higher in elderly females; this may be explained by reduced bone mineral density and reduced trochanteric bone strength. Rigorous preventive treatments of osteoporosis should be considered in high-risk patients, along with improved safety measures to reduce falls.
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Eur J Trauma Emerg Surg · Apr 2014
The effect of evolving trauma care on the development of multiple organ dysfunction syndrome.
Multiple organ dysfunction syndrome (MODS) is still a major threat to polytrauma patients, since sepsis-related organ failure is the most common cause of late mortality in these patients. In this article, the development of trauma surgery and evolution of trauma care from early total care to damage control surgery is discussed. Increasing knowledge of the pathophysiology of trauma has enabled us to identify the inflammatory response induced by trauma. By understanding the pathophysiology, we may be able to fully comprehend the origin of multiple organ dysfunction related sepsis. Further, it is important to appreciate the influence of surgery on the inflammatory response induced by trauma, and subsequently on the development of inflammatory complications. It is crucial to offer the polytrauma patient the appropriate type of surgery at the right time to prevent further deterioration. ⋯ MODS is still highly lethal, and once it has developed it is difficult to treat, so it is vital to be able to predict its occurrence. If we knew how to predict MODS, we might be able to develop strategies to prevent this syndrome.
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Traumatic injury is the leading cause of death worldwide. The rapid evaluation and correction of injuries in these patients is paramount to preventing uncontrolled decompensation and death. Damage control strategies are a compendium of techniques refined over decades of surgical care that focus on the rapid correction of deranged physiology, control of contamination and blood loss, and resuscitation of critical patients. ⋯ Pelvic packing, an adjunct to DCR, provides a means to control hemorrhage from severe pelvic fractures. Temporary vascular shunts restore perfusion, while resuscitation and reconstruction are ongoing. Taken together, these strategies provide the trauma surgeon with a powerful arsenal to preserve life in the transition from injury to the shock trauma room to the intensive care unit.
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β-hemolytic streptococci (βHS) causes a diverse array of human infections. The molecular epidemiology of β-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of β-hemolytic streptococcal infections at a level 1 trauma centre of India. ⋯ β-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.