Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Jun 1992
Comparative Study[Not a tourniquet, but compressive dressing. Experience from 68 traumatic amputations after injuries from mines].
In autumn 1991, 68 patients with traumatic amputations after injuries caused by mines were evacuated to the United Nation's field hospital in the demilitarized zone between Iraq and Kuwait. Most were seen during a three week period when civilians harvested mines. During the first days of this period, continuous bleeding distally to applied tourniquets was frequently observed. ⋯ Fewer patients needed transfusions after the use of tourniquets was discontinued. A tourniquet should not be used in the treatment of bleeding extremity injuries. In extensive crush injuries and traumatic amputations a compressive dressing should be used, applied from the end of the extremity in a proximal direction.
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Tidsskr. Nor. Laegeforen. · Jun 1992
Case Reports[Traumatic pneumopericardium with cardiac tamponade].
A 20 year old male motorist with multiple injuries, including bilateral lung laceration, developed cardiac tamponade 12 hours after injury. X-ray showed characteristic findings of pneumopericardium with air all around the cardiac silhouette, which was diminished in size. A chest tube was inserted intrapericardially through a subxiphoid incision. ⋯ Both patients recovered. Pneumopericardium without symptoms may be treated by observation. Tension pneumopericardium is rare and is best treated by open drainage.
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Tidsskr. Nor. Laegeforen. · Jun 1992
Case Reports[Indirect measurement of intramucosal pH in the gastrointestinal tract using a tonometer. A useful marker of tissue oxygenation in critically ill patients].
Multiple organ failure may develop as a consequence of defective tissue oxygenation, particularly in the gut. Measurements of intramucosal pH (pHi), accomplished by means of a tonometer placed in the stomach or in the sigmoid colon, seem to monitor the degree of mucosal oxygenation very good. The tonometer technique is noninvasive and easy to perform. pHi may be useful as an index to guide therapeutic interventions in critically ill patients.
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Tidsskr. Nor. Laegeforen. · May 1992
[Decision to withdraw cardiopulmonary resuscitation at Norwegian hospitals].
We present a survey on the use of do-not-resuscitate orders in Norwegian hospitals based on mailed questionnaires. 559 doctors, at least one from every somatic hospital in Norway responded. Do-not-resuscitate orders were issued by 92% of these doctors. There were large differences, however, as to who made the decision, who was involved in the decision-making, the consequences of a do-not-resuscitate order, and how the orders were documented. Formal rules for do-not-resuscitate orders are needed.
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The severity of injury inflicted by a missile is determined by the structure hit and retardation of the missile and thus the energy dissipated to the tissue. The injury to tissue depends on the kinetic energy and the construction of the missile, and the density and resilience of the tissue. Devastating, heavily contaminated wounds are inflicted by close-range shotguns and high-energy missiles, and thorough wound debridement and delayed primary closure are required after about four days. ⋯ This injuries primarily hollow organs such as lungs and intestines. Casualties from blasts may exhibit no external symptoms or signs of lung or intraabdominal injury. It is necessary to perform serial physical examinations, blood gas analyses, chest X-ray or CT scan.