Helvetica chirurgica acta
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Helvetica chirurgica acta · Jul 1991
[Helicopter and emergency physician at the accident site. Medical comparison between altitude and flat land emergency care].
In-field intensive care reduces lethality and morbidity in severe trauma. We analyze and compare 400 medical helicopter rescue flights in the region of Basel and 325 medical air-rescues in the mountains of Interlaken. The presence of a physician in the helicopter is based on an interventional concept, with clinical diagnosis, monitoring and early intensive in-field care. ⋯ In spite of high rates of severe conditions in both regions (57% in Basel, 17% in the mountains), the low mortality prior to and during air transport (2.5% in the Basel and 2.7% in the Interlaken region) confirms the necessity of the concept of early in-field intensive therapy. This concept allows good analgesia, is save and comfortable for the patients. The presence of a physician in the air rescue team has to be recommended not only for rescues in the plain, but also in the mountains.
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In the treatment of severe chest injuries with flail chest either positive-pressure mechanical ventilation (and tracheostomy) is necessary or the surgical stabilisation of the chest wall by osteosyntheses of the broken ribs. Fourteen patients (age 27-73) with severe chest injuries and paradoxical respiration were operated and the rib fractures stabilized by means of small reconstruction plates and cerclage wires. ⋯ The results are reported. In severe chest injuries surgical treatment seems to be justified; it reduces the need of artificial respiration and can be recommended.
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Helvetica chirurgica acta · Jul 1991
[Surgical indications, choice of procedure and results in upper gastrointestinal hemorrhage].
Even today acute upper gastrointestinal bleeding carries a high mortality rate. To improve results it is important to define and operate on those patients in whom recurrent bleeding is expected. ⋯ To improve long-term results we propose definitive ulcer surgery even in patients presenting as emergencies. Implementation of this policy does not increase operative mortality.