Journal of emergencies, trauma, and shock
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J Emerg Trauma Shock · Jan 2011
Impact of general versus epidural anesthesia on early post-operative cognitive dysfunction following hip and knee surgery.
Post-operative cognitive dysfunction is the subtle cerebral complication temporally seen following surgery. The aim of this study was to compare the influence of either general anesthesia (GA) or epidural anesthesia (EA) on the early post-operative neurocognitive outcome in elderly (>59 years) subjects undergoing hip and knee surgery. ⋯ We observed a difference in cognitive outcome with GA compared with EA. Certain aspects of the cognition were affected to a greater extent in this group of patients undergoing hip and knee surgery.
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J Emerg Trauma Shock · Oct 2010
Prevalence and patterns of combat sport related maxillofacial injuries.
This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes. ⋯ In this study, prevalence of facial injuries from combat sports professionals was significantly high (roughly 80%), especially in kickboxing (in part due to use of less protective gear). Because the nose and teeth sustained the most injuries, they require more attention with regard to prevention. Kickboxing was the most injurious of these combat sports and caused the most significant number of maxillofacial trauma. More safety apparel and protective guards seem warranted in athletes of combat sports if facial injury is to be prevented.
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J Emerg Trauma Shock · Oct 2010
Human factors in resuscitation: Lessons learned from simulator studies.
Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR). Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. ⋯ Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.
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J Emerg Trauma Shock · Oct 2010
Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock.
New scoring systems, including the Rapid Emergency Medicine Score (REMS), the Mortality in Emergency Department Sepsis (MEDS) score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65) score, have been developed for emergency department (ED) use in various patient populations. Increasing use of early goal directed therapy (EGDT) for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined. ⋯ We found that all three ED-based systems for scoring severity of illness had low to moderate predictive capability. The MEDS score demonstrated the largest AUC of the studied scoring systems for the outcome of mortality, although the CIs on point estimates of the AUC of the REMS and CURB-65 scores all overlap.