The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2012
Pattern and mechanism of traumatic limb amputations after explosive blast: experience from the 07/07/05 London terrorist bombings.
Traumatic amputation of limbs caused by bomb blast carries a high mortality; we present our experience of 07/07 London terrorist bombing that resulted in a large number of survivors with amputated limbs. We think that the unique underground bombing, the shape of the carriages, and the enclosure by the underground tunnel caused amputation of the limb by the channeling of the blast wave as a result of the device being floor based, which resulted in lower-limb amputation without other fatal primary blast injuries. We present our results of the traumatic amputation in the fatalities and survivors as well as the possible mechanism and protective measure that could save lives. ⋯ Epidemiological study, level V.
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J Trauma Acute Care Surg · Jul 2012
Review Meta AnalysisPrehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis.
The majority of trauma deaths in the developing world occur outside of the hospital. In the mid-1990s, preliminary studies of prehospital trauma systems showed improvements in mortality. However, no empirical data are available to assess the overall benefit of these systems. We undertook a systematic review and meta-analysis to assess the effectiveness of prehospital trauma systems in developing countries. ⋯ Meta-analysis, level III+.
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J Trauma Acute Care Surg · Jul 2012
Randomized Controlled TrialNext generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system.
Distal locking marks one challenging step during intramedullary nailing that can lead to an increased irradiation and prolonged operation times. The aim of this study was to evaluate the reliability and efficacy of an X-ray-radiation-free real-time navigation system for distal locking procedures. ⋯ Therapeutic study, level II.
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J Trauma Acute Care Surg · Jul 2012
Endothelial glycocalyx degradation induces endogenous heparinization in patients with severe injury and early traumatic coagulopathy.
There is emerging evidence that early trauma-induced coagulopathy (TIC) is mechanistically linked to disruption of the vascular endothelium and its glycocalyx, assessed by thrombomodulin and syndecan 1, respectively. This study evaluated if degradation of the endothelial glycocalyx and ensuing release of its heparin-like substances induce autoheparinization and thereby contributes to TIC. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Jul 2012
Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.
Most surgical critical care literature reflects practices at trauma centers and tertiary hospitals. Surgical critical care needs and practices may be quite different at nontrauma center teaching hospitals. As acute care surgery develops as a component of surgical critical care and trauma, the opportunities and challenges of the nontrauma centers should be considered. ⋯ Therapeutic study, level II.