The Surgical clinics of North America
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More than 650 deaths from hypothermia occur each year in the United States. Even minor deviation from normal temperature leads to important symptoms and disability. ⋯ It also looks at the controversial protective role hypothermia might play in shock, organ transplantation, cardiac arrest, and brain injury. Finally, it examines cold injuries, including frostbite, chilblain, and trench foot, and makes recommendations for their treatment.
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Surg. Clin. North Am. · Feb 2007
Review Case ReportsInjury in the elderly and end-of-life decisions.
The elderly constitute the fastest growing sector of the population of the United Stated and geriatric trauma patients are presenting for care with increasing frequency. These patients are challenging particularly because of their vulnerability to severe injury, limited physiologic response to stress, and frequent presence of comorbid medical conditions complicating care. Many elderly trauma victims require prolonged intensive care and some fail to improve or succumb despite the best efforts because of the extent of their injuries and their underlying disease. These patients may present profound ethical challenges for trauma surgeons as the goals of care shift from salvage to end-of-life care.
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Hemorrhagic shock is the leading cause of death in civilian and military trauma. Effective hemorrhage control and optimal resuscitation are the main goals in the management of severely injured patients. ⋯ Much of these changing trends are caused by the recognition that the current method of resuscitation with crystalloid fluids may not be optimal and may even have detrimental consequences. This article summarizes a number of studies that have evaluated the cellular toxicities of commonly used resuscitation fluids, to highlight the need for the development of new fluids.
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Emergency medical services (EMS) play a critical role in the trauma system as the point of initial patient care and stabilization and in determining the regional flow of patients and the commitment of resources to the critically injured. Trauma surgeons and emergency physicians need to be involved in the organizational planning of EMS systems to ensure that uniform patient care protocols are developed for triage and treatment. Ongoing efforts should focus on addressing national variability in care provided after injury to ensure optimal outcome for patients in all regions. Through additional research, the best practice and optimal EMS system design will continue to be defined.