European journal of trauma and emergency surgery : official publication of the European Trauma Society
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The objective of our study was to evaluate the safety and accuracy of ultrasound (US) compared to standard radiographs in diagnosing supracondylar fractures (SCFs) of the humerus in children. ⋯ By identifying a positive dFP sign and/or cortical lesions of the distal humerus, SCFs can be detected very sensitively by US. Even the estimation of fracture displacement seems to be possible. We suggest US as an applicable alternative method in the primary evaluation of suspected SCF in children, guiding further diagnostics, where appropriate. After minor injuries, if clinical assessment for an elbow fracture is low and US examination is negative for fracture, additional radiographs are dispensable. Thereby, the amount of X-ray burden during childhood can be reduced, without loss of diagnostic safety.
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Needlestick injuries (NSIs) are a significant health hazard. Occupational transmission of bloodborne pathogens among healthcare workers (HCWs) is rare but has been repeatedly reported in the literature. ⋯ An NSI is an emergency and needs to be evaluated immediately and, if necessary, treated as soon as possible. A standardized algorithm for initial diagnostic and treatment has proven to be helpful.
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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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Eur J Trauma Emerg Surg · Apr 2014
Polytrauma at the Emergency Department; can we relate arterial blood gas analysis to a shock classification?
Shock is defined as a change of circulation which results in hypoxia at the tissue level. Lactate and base deficit (BD) are associated with a high risk of multiple organ dysfunction in trauma patients. In this study we evaluated the influence of early recognition of shock in trauma patients. ⋯ Prehospital shock influences patient outcome; outcome of patients is related to initial shock classification. Further validation of our shock classification, however, is necessary.