Der Unfallchirurg
-
Trauma has been described as a "disease of bleeding" [45]. Recognition of acute blood loss after injury, and restoration of homeostasis is the cornerstone of the initial care of the badly injured patient. Hypovolaemia remains the most common cause of death among those killed in action during military conflicts [46] and, in the civilian arena, increasing numbers of patients are being encountered with penetrating injuries, even in societies where blunt injury have previously been the norm. ⋯ Successful outcomes after the treatment of patients with penetrating trauma depend on the integration of many agencies, from prehospital care, initial reception, assessment and resuscitation through the operating room, intensive care and post-injury rehabilitation. Recognition of the importance of time and adherence to sound trauma management principles with conservative management when appropriate should see further improvements in our treatment of this important group of patients. Reducing the incidence of these injuries is the responsibility of us all and must be the focus of all governmental initiatives.
-
Is the measurement of continuous cardiac output useful for the management of polytrauma patients? ⋯ The unique opinion was that the CCO device had an impact on their decision making in the fluid and drug management of the study patients. Our first experience, however, suggests that this device may become an important improvement in the management of haemodynamics in the early trauma phases. Before a wide-spread application of this method on the ICU an evidence based prospective randomized trial should be performed.
-
Comparative Study
[Constant Score and Neer Score. A comparison of score results and subjective patient satisfaction].
The Constant- and the Neer-Score are widely used to assess shoulder function after trauma or shoulder diseases. The objective of this study was to compare the correlation of score result with the patient subjective assessment. We hypothesized that there is a clinically relevant difference between the score result and the patient assessment, especially for highly selective patient groups. ⋯ The hypothesis of a clinically relevant difference between the subjective and the score-based assessment of shoulder function can be confirmed. Our results suggest that for clinical practice, statements and therapy strategies recommended in the literature, that are just based on score results might not be valid for all patient-groups (e.g. elderly patients).