Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 8 Articles
Parallel screw alignment can be challenging. We describe a simple, reproducible technique for the fixation of the medial malleolar fragment with two parallel screws, using a 1.6mm K-wire and the small fragment AO drill-guide....
Background: Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement\r\nand organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar\r\ntechniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip) are currently\r\ncommercially available. This study was performed to detect any difference with respect to time until tube insertion,\r\nto success and to misplacement rate.\r\nMethods: Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped\r\ntube kits in 100 fresh human cadavers (100 thoracostomies with each kit). Time until tube insertion served as\r\nprimary outcome. Complications and success rate were examined by pathological dissection and served as further\r\noutcomes parameters.\r\nResults: Difference in mean time until tube insertion (63s vs. 59s) was statistically not significant. In both groups,\r\ntime for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver�s BMI and on\r\nthe individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped\r\nkits) and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p =\r\n0.04).\r\nConclusion: Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related\r\ncomplication rate. No difference in average time could be found. However, misplacements and organ injuries\r\noccurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is\r\nrecommended....
Background: Formalized trauma systems have shown beneficial effects on patient survival and have harvested\r\ngreat recognition among health care professionals. In spite of this, the implementation of trauma systems is\r\nchallenging and often met with resistance.\r\nRecommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level\r\nof implementation of these recommendations.\r\nMethods: A survey of all acute care hospitals that receive severely injured patients in the south-eastern health\r\nregion of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was\r\nused in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma\r\nsystem criteria were identified from the recommendations.\r\nResults: Nineteen hospitals were included in the study and these received more than 2000 trauma patients\r\nannually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of\r\n12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre\r\naffected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients\r\nto higher level of care and on the training requirements for members of the trauma teams.\r\nConclusion: Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The\r\nfindings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from\r\nthe national trauma system recommendations. Resources for training of personnel partaking in trauma teams and\r\ndevelopment of inter-hospital transfer agreements should receive immediate attention....
Background: Efficient and accurate patient tracking during high-throughput situations is critical, especially for resource-limited medicine incurred during natural disasters, terrorist events, chemical threats and other mass casualty situations. Use of air traffic control practices modified to track patients shows promise in military medical applications. We tested a similar application in a busy, level 1 trauma center utilizing a system we call the Mass Casualty Tracking Application (MCTA).\r\n Methods: Third party surveyors compared current system to a system using MCTA on sixty four patients in July 2010. Four data points on paired patients were surveyed randomly each hour resulting in 56 total surveys with 50 useable. Written opinion comments were submitted by four staff members exposed to both systems.\r\n Results: Overall, MCTA had no significant difference in errors compared to FirstNet regarding patient data. Hospital staff exposed to both systems preferred FirstNet over MCTA due to familiarity. Hospital staff surveyed for comments on the MCTA indicated that they envisioned the system would be very useful for power outages and/or mass casualty incidents, for determining bottlenecks in patient flow, for tracking patients sent for imaging with useful prompting to seek out imaging read results and as a backup to FirstNet.\r\n Conclusions: MCTA in a busy trauma center is equivalent in its ability to track patients in this specific highthroughput system regarding data correctness/patient location. Though not designed as a replacement to electronic systems, MCTA is capable of performing this task and may be a useful asset for mass casualty events and/or as a backup system due to its ââ?¬Å?pen and inkââ?¬Â simplicity....
Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more than 95% of cases.\r\n Objectives: In this article we report two cases of blunt chest trauma, underlining the relationship between Macklin effect, pneumomediastinum and pneumoperitoneum, and analysing conservative and invasive treatment.\r\n Case reports: We report two cases of blunt chest trauma with Pneumomediastinum creation and no evidence of airway lesions. The first patient presented with malignant pneumomediastinum, created by Macklin effect, and pneumoperitoneum with intra-abdominal hypertension. He underwent invasive treatment.\r\n The second case shows how Macklin effect can be self-limiting. This patient underwent conservative treatment.\r\n Conclusions: In any case of post-traumatic pneumomediastinum, the Macklin effect should be suspected. Clinical observation is the treatment of choice since Macklin effect is self-limiting. There are some life-threatening event, like malignant pneumomediastinum and intra-abdominal hypertension that must be relieved and treated immediately....
Recently, prosthetic replacement has been commonly applied as a standard procedure for the elbow joint destruction by arthritis or trauma, and elbow arthrodesis has been used only for patients who are unsuitable for other conventional treatment methods. In most cases, ulnohumeral arthrodesis is performed, considering the geometry and the amount of surface area of the distal humerus and proximal ulna. In this report, we present a successful case of the radiohumeral arthrodesis using unilateral external fixation without bone grafting for a patient who sustained severe open communited fracture with transarticular massive bone loss. We decided to fuse the elbow at 70 degrees of flexion, and the forearm was fixed at 80 degrees of pronation. At 13-month after the operation, radiographic evidence of solid enlarged right elbow fusion was gained. At more than three years after operation, we evaluated patient-oriented quantitative functional disability using Disabilities of the Arm, Shoulder and Hand (DASH) to confirm that radiohumeral arthrodesis fixed at this angle could be accepted. This technique can be recommended as a salvage procedure in the face of significant bone loss of the proximal ulna....
Subacute progressive ascending myelopathy is a rare, poorly understood neurological complication of spinal\r\ncord injury, unrelated to mechanical compression, instability, or syrinx formation at the level of injury or above. To\r\ndate, there is no known treatment for this dramatic spinal cord injury complication. We present a case of subacute\r\nprogressive myelopathy after lumbar spine trauma. The therapy consisted of plasmapheresis, hyperbaric oxygen,\r\nhigh-dose cortisol, antibiotic, and antiviral drugs. At 1 year post injury, the patient had recovered most of his lost\r\nupper-extremity function and MRI demonstrated only discrete signal intensity alterations extending to T3/4....
The Advanced Trauma Life Support (ATLS) Program was developed to teach doctors one safe,\r\nreliable method to assess and initially manage the trauma patient. The ATLS principles represents\r\nan organized approach for evaluation and management of seriously injured patients and offers a\r\nfoundation of common knowledge for all members of the trauma team. After 3 decades of teaching\r\n(1978ââ?¬â??2008) of ATLS worldwide one should intuitively perceive that the evidence for the effect of\r\nATLS teaching on the improved management of the injured patient be well established. This\r\neditorial addresses aspects of trauma education with needs for further development of better\r\nevidence of best practice....
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