Revista do Colégio Brasileiro de Cirurgiões
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The percutaneous dilatational tracheostomy has become the technique of choice in the Intensive Care Unit, due safety and facilities to be performed at bedside, wich may overcome the risks associated with transport of critically ill patients to the Operating Room. Proponents of percutaneous dilatational tracheostomy suggest that the limited dissection results in less tissue damage, lowers the risk of bleeding and wound infection. The aim of this study is to review the techniques of percutaneous dilatational tracheostomy through a critical analysis of it's indications, contra-indications and complications, as well to compare percutaneous dilatational tracheostomy to surgical tracheostomy. This manuscript analysis and synthesizes randomized prospective studies, meta-analysis and systematic reviews, comparing both techniques in adult critically ill patients in the Intensive Care Unit.
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To understand the human factor as a threat to the security of trauma patients in the operating room, bringing to the operating room some important rules already applied in the field of aviation. ⋯ Interruptions and distractions are frequent and should be studied by the trauma surgeon to develop prevention strategies and lines of defense to minimize them and reduce their effects.
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Comparative Study
Pelvic fractures as a marker of injury severity in trauma patients.
To assess whether the presence of a pelvic fracture is associated with greater severity and worse prognosis in victims of blunt trauma. ⋯ The presence of a pelvic fracture is a marker of greater severity and worse prognosis in victims of blunt trauma.
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to assess the value of computed tomography in the diagnosis of cervical spine and spinal cord injuries in victims of blunt trauma. ⋯ we gathered medical records from 3,101 victims. Computed tomography was performed in 1572 (51%) patients, with male predominance (79%) and mean age of 38.53 years in Group I and 37.60 years in Group II. The distribution of trauma mechanisms was similar in both groups. Lesions found included: 53 fractures, eight vertebral listeses and eight spinal cord injuries. Sequelae included: paraplegia in three cases, quadriplegia in eight and brain injury in five. There were seven deaths in Group II and 240 in Group I. The average length of hospital stay was 11 days for Group I and 26.2 days for Group II. CONCLUSION. A CT scan of the cervical spine in victims of blunt trauma was effective in identifying lesions of the cervical spine and spinal cord injuries. Thus, despite the cost of neck CT and the low incidence of lesions identified by it, its indication based on the usual criteria seems justified.