The Surgical clinics of North America
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Surg. Clin. North Am. · Aug 2012
Review Historical ArticleLong-range critical care evacuation and reoperative surgery.
Long-range critical care aeromedical evacuation has significantly contributed to the unprecedented survival during recent military operations. With advances in critical care, patients with increased injury severity and overall complexity are routinely evacuated while resuscitation is ongoing. Additional specialty teams now provide advanced pulmonary rescue therapies for the most critically ill patients. As part of the continuum of trauma care, an overseas fixed facility provides follow-on emergency surgical critical care to optimize patient outcomes before final evacuation to the continental United States.
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The philosophy of damage control surgery has developed tremendously over the past 10 years. It has expanded outside the original boundaries of the abdomen and has been applied to all aspects of trauma care, ranging from resuscitation to limb-threatening vascular injuries. In recent years, the US military has taken the concept to a new level by initiating a damage control approach at the point of injury and continuing it through a transcontinental health care system. This article highlights many recent advances in damage control surgery and discusses proper patient selection and the risks associated with this management strategy.
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Surg. Clin. North Am. · Aug 2012
ReviewManagement of complex extremity injuries: tourniquets, compartment syndrome detection, fasciotomy, and amputation care.
Historically, complex extremity injuries, otherwise known as mangled extremities, have been difficult management problems. This is especially true in multiply-injured patients where many priorities exist and where amputation is considered a failure of limb salvage. Over the past decade, advances in the total management of complex extremity injuries, from the placement of life-saving and limb-saving tourniquets in the prehospital setting to the advancement of prosthetics and rehabilitation months to years later, have resulted in superb functional results regardless of whether limb salvage or amputation is undertaken.
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Prehospital care of the trauma patient is continuing to evolve; however, the principles of airway maintenance, hemorrhage control, and appropriate resuscitative maneuvers remain central to the role of the emergency medical care provider. Recent changes in the regulations for research in emergency settings will allow randomized trials to proceed to test new devices, drugs, and resuscitative strategies in the prehospital environment. The creation of prehospital research networks will provide the appropriate infrastructure to greatly facilitate the development of new protocols and the execution of large-scale randomized trials with the potential to change current prehospital practice.
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Surg. Clin. North Am. · Aug 2012
ReviewVerification and regionalization of trauma systems: the impact of these efforts on trauma care in the United States.
Efforts to develop trauma systems in the United States followed the publication of the landmark article, "Accidental Death and Disability: The Neglected Disease of Modern Society," by the National Academy of Sciences (1966) and have resulted in the implementation of a system of care for the seriously injured in most states and within the US military. In 2007, Hoyt and Coimbra published an article detailing the history, organization, and future directions of trauma systems within the United States. This article provides an update of the developments that have occurred in trauma systems in system verification and regionalization.