Current opinion in critical care
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The prehospital care of injured patients has been surrounded with much controversy over the years. This controversy exists regarding the specific interventions used on-scene and en-route to definitive care centers, regarding the overall approach to the care of these patients (advanced life support versus basic life support) and with regards to who should be providing this care. This section of the journal aims to review the most current literature concerning these topics as well as highlight some important and relevant literature preceding it. ⋯ There is no convincing evidence that prehospital advanced life support in the urban setting provides any benefit to injured patients in terms of either morbidity or mortality.
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This article reviews new aspects about the significance, diagnosis and treatment of different chest injuries. ⋯ Faster and more detailed diagnosis of thoracic injuries has been achieved by multislice computed tomography. The modern management of thoracic injuries is complex. Minimally invasive techniques (thoracoscopic surgery, endovascular repair) and recent developments in lung supportive therapies reduce mortality and morbidity. However, emergency thoracotomy is still an important and valuable approach for life-saving or damage-control procedures.
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Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. ⋯ Critical care teams perform many activities where effective communication is crucial for ensuring patient safety and reducing susceptibility to error. To develop valid team training and assessment tools for improving teamwork in the intensive care unit there is a requirement to better understand and identify the specific communication skills important for safety during the provision of intensive care medicine.
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Curr Opin Crit Care · Dec 2007
ReviewAcute coagulopathy of trauma: mechanism, identification and effect.
Acute coagulopathy of trauma has only been described relatively recently. Developing early in the postinjury phase, it is associated with increased transfusion requirements and poor outcomes. This review examines the possible initiators, mechanism and clinical importance of acute coagulopathy. ⋯ Acute coagulopathy results in increased transfusion requirements, incidence of organ dysfunction, critical care stay and mortality. Recognition of an early coagulopathic state has implications for the care of shocked patients and the management of massive transfusion. Identification of novel mechanisms for traumatic coagulopathy may lead to new avenues for drug discovery and therapeutic intervention.
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Trauma systems are introduced world wide with the goal to improve survival and outcome of the injured patient. This review is focused on the influence of trauma systems on the survival and outcome of injured patients. ⋯ Trauma systems indeed improve survival rates in injured patients. Inclusive trauma systems do better than exclusive trauma systems. More attention should be given to quality of outcome.