Emergency medicine journal : EMJ
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Hypovolaemic shock that results through traumatically inflicted haemorrhage can have disastrous consequences for the victim. Initially the body can compensate for lost circulating volume, but as haemorrhage continues compensatory mechanisms fail and the patient's condition worsens significantly. Hypovolaemia results in the lethal triad, a combination of hypothermia, acidosis and coagulopathy, three factors that are interlinked and serve to worsen each other. ⋯ This method is easy to implement requiring simple protocols and contributes significantly to interrupting the lethal triad. However, the future of trauma care appears to lie with clinically induced therapeutic hypothermia. This new treatment provides optimism that in the future the number of deaths resulting from catastrophic haemorrhaging may be significantly lessened.
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A short-cut review was carried out to establish whether leeches or steroids are more effective at reducing the size of a tongue haematoma. No studies were directly relevant to the question. Several reviews and case reports were found to suggest that leeches might be effective. The clinical bottom line is that leeches should be considered in the management of obstructive traumatic tongue swelling.
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A short-cut review was carried out to establish whether levosimendan improves outcome in cases of cardiogenic shock. Five studies were directly relevant to the question. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1. The clinical bottom line is that there is no evidence that levosimendan improves outcome in cardiogenic shock.
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This paper reviews the current evidence available on the practice of spinal immobilisation in the prehospital environment. Following this, initial conclusions from a consensus meeting held by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in March 2012 are presented.