Injury
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Comparative Study
Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport.
Recent studies suggest that mode of transport affects survival in penetrating trauma patients. We hypothesised that there is wide variation in transport mode for patients with gunshot wounds (GSW) and there may be a mortality difference for GSW patients transported by emergency medical services (EMS) vs. private vehicle (PV). ⋯ Wide variation exists in transport mode for GSW patients across the United States. Mortality may be higher for GSW patients transported by EMS when compared to private vehicle transport. Further studies should be performed to examine this question.
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To describe the association between increasing age, pre-hospital triage destination compliance, and patient outcomes for adult trauma patients. ⋯ Despite effective pre-hospital trauma triage criteria, older trauma patients are less likely to be transported to a major trauma service and have poorer outcomes than younger adult trauma patients. It is likely that the benefit of access to definitive trauma care may vary across age groups according to trauma cause, patient history, comorbidities and expected patient outcome. Further research is required to explore how the Victorian trauma system can be optimised to meet the needs of a rapidly ageing population.
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Comparative Study
Massive blood transfusions post trauma in the elderly compared to younger patients.
Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients ≥65 years old and explore variables associated with poor outcomes. ⋯ Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.
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Case Reports
Rescue extracorporeal membrane oxygenation in a young man with a stab wound in the chest.
A 27-year-old man with haemorrhagic shock and acute cardiac tamponade due to a stab in the chest underwent successful resuscitation and surgical repair of the right ventricular perforation thanks to the use of extracorporeal membrane oxygenation (ECMO) in the emergency department. To the best of the authors' knowledge, this is the first report around the use of ECMO to rescue a victim of a penetrating cardiac trauma. The physicians who have portable ECMO device should be aware of this option when a life-threatening internal bleeding in haemodynamically unstable patients could be quickly controlled by surgery, even if performed in ill-suited settings.
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Comparative Study
Use of AUDIT-C as a tool to identify hazardous alcohol consumption in admitted trauma patients.
Alcohol use is an important contributor to injuries. Simple bedside tools to identify trauma patients with potentially harmful drinking may assist in brief intervention efforts in clinical practice. The objective of the study was to determine and compare the accuracy of alcohol use disorders identification test (AUDIT) and an abbreviated version of this test, in the detection of hazardous drinking. ⋯ AUDIT-C appears to be a potentially useful screening tool for use trauma centres, but that further research with larger samples is required.