Articles: trauma.
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Australas Emerg Nurs J · Nov 2013
Observational StudyThai emergency nurses' management of patients with severe traumatic brain injury: comparison of knowledge and clinical management with best available evidence.
In Thailand, the rate of TBI-related hospitalisation is increasing, however, little is known about the evidence-based management of severe TBI in the developing world. The aim of this study was to explore Thai emergency nurses' management of patients with severe TBI. ⋯ There is variation in Thai nurses' knowledge and care practices for patients with severe TBI. To increase consistency of evidence-based TBI care in the Thai context, a knowledge translation intervention that is ecologically valid, appropriate to the Thai healthcare context and acceptable to the multidisciplinary care team is needed.
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Methemoglobinemia is a relatively common, potentially fatal syndrome resulting from oxidative stress. Of the numerous causes identified, toxins are the most common precipitating event. ⋯ This case describes an uncommon presentation of a common toxicologic condition and presents a discussion regarding the evaluation, management, and pathophysiology of methemoglobinemia.
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In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients. ⋯ Level IV, retrospective case series.
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Following the introduction of changes to the trauma system there would be a period of time during which the impact on mortality would be minimal. A decrease in mortality rates would be noted as the TS matured and would continue over time. ⋯ A steady significant reduction in the inpatient mortality rate for severe trauma patients hospitalized at all level I trauma centres in Israel between 2000 and 2010 was observed. Although a single factor that explains the reduction was not identified, evidently the establishment of the trauma system brought about a significant decrease in hospital mortality. Integrated cooperation between components of the national trauma system in Israel over the years may explain the reduction.
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The authors discuss the use of scavenged tissue for reconstruction of an injured limb, also referred to as "spare-part surgery." It forms an important part of overall reconstructive strategy. Though some principles can be laid down, there is no "textbook" method for the surgeon to follow. ⋯ Requirements for limb reconstruction vary from simple solutions such as tissue coverage, which include skin grafts or flaps to more complex planning as in functional reconstruction of the hand, where the functional importance of individual digits as well as the overall prehensile function of the hand needs to be addressed right from the time of primary surgery. The incorporation of the concept of spare-part surgery allows the surgeon to carry out primary reconstruction of the limb without resorting to harvest tissue from other regions of the body.