Läkartidningen
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The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. ⋯ Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.
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Patients with severe sepsis/septic shock have a high mortality. Beta-lactam antibiotics are normally first line treatment. ⋯ We have reviewed 14 randomized controlled studies to investigate whether prolonged infusion provides lower mortality and/or increased clinical cure. In summary, convincing advantages with prolonged infusion could not be found, however randomized studies are heterogeneous, and it cannot be excluded that some subgroups of critically ill patients could benefit from such treatment.
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The return to a good life after successfully resuscitated cardiac arrest may be hindered by cardiovascular morbidity, psychological distress and the consequences of anoxic brain injury. To support the return to everyday life, patients and their relatives are in need of health care follow-up with multiple focuses. Usually, this follow-up consists of at least one of three parallel tracks; cardiology for interventions and secondary prevention, post intensive care follow-up to capture and prevent consequences of the traumatic event and the ICU stay, or neurological follow-up for patients with neurological sequels. ⋯ In addition, survivors are usually included and followed with patient related outcome measures (PROM) through the multiple Swedish national quality registers. The different clinical follow-up systems and the registers are not coordinated and assessments and questions may be repeated multiple times. A more integrated follow-up model has the potential to benefit the patient and their relatives and to reduce costs.
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The main purpose was to study the prehospital and early intrahospital treatment of patients with traumatic brain injury (TBI) in the county of Västerbotten 2011-2012. In total, 162 patients were included. ⋯ Furthermore, most patients were initially relatively unaffected by the injury and around 1/5 of the patients were transported to hospital by private transport. Finally, we observed that most patients were admitted to hospital and computer tomography scan of the head was performed within 4 hours.