Articles: trauma.
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Severe lower limb trauma with significant soft tissue injury can be managed with reconstruction or, if this is impossible, amputation. If amputation is considered, below-knee amputation preserving limb length is optimal for long-term functional outcome. ⋯ The procedure was technically challenging and required follow-up debulking operations. However, the technique provided the significant advantage of immediate sensation of robust glabrous distal stump cover and optimising leg length to enhance functional outcome.
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Eur J Trauma Emerg S · Aug 2013
Pain and quality of life 1 year after admission to the emergency department: factors associated with pain.
This study describes the prevalence of pain in trauma patients 1 year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain. ⋯ Pain is strongly associated with psychosocial complaints 1 year after trauma. For the treatment of pain following a traumatic event, social reintegration and emotional regulation by means of occupational rehabilitation and psychotherapy should receive more attention.
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A quarter of trauma-related deaths are attributable to traumatic chest injury (TCI). ⋯ TCI is an alarming problem in Qatar, with a bimodal mortality curve. The highest mortality peak occurred in children, followed by old age. However, young males are the most exposed population. Regulatory efforts and strict enforcement of traffic laws would likely reduce morbidity and mortality.
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Eur J Trauma Emerg S · Aug 2013
Management of chronic traumatic arteriovenous fistula of the lower extremities.
Vascular injuries secondary to blunt or penetrating trauma are a significant cause of morbidity and mortality, especially in war-afflicted areas. Due to the violent situations of Pakistan and the unavailability of vascular services in remote areas, we are witnessing an increase in the number of delayed/chronic post-traumatic arteriovenous fistulas (AVFs) of the extremities in our institution. The purpose of this study is to share our experience of post-traumatic AVF and the incidence, presentation, and outcomes of these patients. ⋯ Long-standing traumatic AVF is becoming common in Pakistan. Surgery remains the standard treatment.
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Hemorrhage remains one of the leading causes of trauma-related deaths. Uncontrolled diffuse microvascular bleeding in the course of initial care is common, potentially resulting in exsanguination. Early and aggressive hemostatic intervention increases survival and reduces the incidence of massive transfusion. ⋯ This strategy addresses important confounders of the coagulation process such as hemodilution, hypothermia, and acidosis; DCR is based on a damage control surgical approach, permissive hypotension, and improvement of hemostatic competence. Many studies have shown benefit in mortality when using high ratios of fresh frozen plasma (FFP) to red blood cells (RBC) as early treatment. However, there is increased awareness that coagulation factor concentrate could be beneficial in the treatment of trauma-induced coagulopathy.