Canadian journal of surgery. Journal canadien de chirurgie
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Patient management in the prehospital resuscitative phase after trauma is vitally important to the outcome. Early definitive care remains the essential element in improving morbidity and mortality. In Canada, where a large proportion of trauma occurs at sites distant from a trauma centre, the prehospital resuscitative phase is long and has even greater potential to affect outcome. ⋯ In penetrating torso injury in an urban setting, there is evidence to suggest that delaying resuscitation until hemorrhage is controlled is beneficial. More Canadian clinical trials are required in this area. In the meantime, the priorities of resuscitation must be carefully assessed for each patient and pattern of injury.
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The authors review the principles of reconstructive surgery for lower limb salvage after severe lower limb trauma to determine factors that have been used as decision-making criteria for limb salvage or amputation in severe lower extremity injuries and the methods of reconstruction and their outcome. The use of scoring systems and their value in acute decision making (primary amputation or limb salvage) are described. ⋯ It is essential for the physician to make a good initial decision on the need for primary amputation or limb salvage. A multidisciplinary approach is fundamental to successful salvage.
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Review Comparative Study
Diagnostic peritoneal lavage versus abdominal computed tomography in blunt abdominal trauma: a review of prospective studies.
To determine whether abdominal computed tomography (CT) or diagnostic peritoneal lavage (DPL) should be used in the evaluation of hemodynamically stable patients with blunt abdominal trauma and equivocal findings on physical examination. ⋯ DPL should be performed if there are no contraindications and no associated injuries that would be better delineated by CT, in which case abdominal CT is indicated.
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To familiarize the surgeon with problem-based learning (PBL) and to discuss the current and future role of PBL in undergraduate surgical education. ⋯ Centres that have adopted a PBL approach have found improved student motivation and enjoyment, but there has been no convincing evidence of improved learning. An intelligent combination of both traditional and PBL approaches will likely provide the most effective training for undergraduate surgical clerks.
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The ability to transfuse blood (a form of tissue transplantation) with relatively few immediate and long-term complications has led to increased survival in victims of injury who require massive amounts of blood. The primary deficit in hypovolemic shock secondary to trauma is in oxygen transport to the hypoperfused tissues; therefore, blood transfusion has an essential role in therapy during resuscitation and definitive treatment. ⋯ With improved screening techniques and heightened donor awareness, the risk of disease transmission is less than 2%. Until synthetic oxygen-carrying solutions are available, the transfusion of red blood cells, when appropriately indicated, will remain an important component in the resuscitation of the trauma patient.