Injury
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Morel-Lavallée lesion is a rare cause of subcutaneous swelling, caused by post-traumatic shearing of the hypodermis from the underlying fascia. Treatment of such lesions is still not well established. ⋯ Closed degloving injuries can be managed satisfactorily with doxycycline induced obliteration of the cavity with early healing time without recurrences.
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High rates of trauma recidivism associated with alcohol use indicate the need to screen for alcohol consumption and related harm. Routine collection of prevalence data relating to alcohol use in Australian trauma settings is not undertaken currently, and diverse screening approaches are used across different settings. This study sought to examine the feasibility of routine screening for alcohol related injury and harmful alcohol use, and determine the prevalence of alcohol related injury and risky alcohol consumption amongst trauma patients in Western Australia. ⋯ Preliminary findings suggest a high prevalence of alcohol-related injury, and harmful alcohol consumption. These findings point to an urgent need to develop reliable and economical screening protocols for harmful alcohol use across Australian trauma settings and the adoption of strategies to ensure their compliance, to enable accurate identification of those most likely to benefit from interventions to reduce alcohol related harm.
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The pathophysiology and time-course of coagulopathy post major burns are inadequately understood. The aims of this study were to review the incidence of acute coagulopathy post major burns, potential contributing factors associated with this coagulopathy and outcome of patients who developed early coagulopathy. ⋯ Post major burns, a very low proportion of patients presented with coagulopathy, but a substantial proportion of patients developed coagulopathy within 24 h. This and the association of coagulopathy with the volume of fluid resuscitation suggest dilution as a major cause of the early coagulopathy of major burns.
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Standard venous thromboembolism (VTE) prevention for critically ill trauma patients includes sequential compression devices and chemical prophylaxis. When contraindications to anticoagulation are present, prophylactic inferior vena cava filters (IVCF) may be used to prevent pulmonary emboli (PE) in high-risk patients, but specific indications are lacking. We sought to identify independent predictors of VTE in critically-ill trauma patients who cannot receive chemical prophylaxis in order to identify a subset of patients who may benefit from aggressive screening and/or prophylactic IVCF placement. ⋯ VTE occur in 7% of critically injured trauma patients who cannot receive chemical prophylaxis. Aggressive screening and/or prophylactic IVCF placement may be considered in patients with a PMH of DVT or extremity fractures when anticoagulation is prohibited.
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The objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients. ⋯ Aortic injuries in crush thoracic trauma patients seem to present in a different clinical scenario from aortic injuries in high-speed thoracic trauma thus requiring distinct considerations. When planning the initial management of aortic injuries in crush trauma, the increased risk of rhabdomiolysis and subsequent acute renal failure, as well as a tendency to develop lower-risk aortic wall injuries, must be considered.