Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2012
Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons.
The incidence of gunshot wounds from civilian firearms is increasing. Despite this fact, guidelines on indications for bullet removal are scarce. In this analysis, we combine an overview of the available literature in these rare entities with our experiences in our own clinical practices. ⋯ In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.
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The aim of our study was to analyze the pattern of injuries, hospital care, and outcome of the victims of suicide bomb attacks in Pakistan. ⋯ Most of the problems encountered were logistic in nature. Early evacuation of the victims remains pivotal in saving lives. The major causes of death in peripheral patients was hypovolemic shock, sepsis, and hypothermia. Mortality and morbidity can be enhanced by ample fluid resuscitation, tetanus prophylaxis, and proficient first aid at the site of injury.
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Volkmann's ischaemic contracture is a devastating condition with serious motor and sensory functional implications for the affected limb. This clinical review outlines acute compartment syndrome and Volkmann's ischaemic contracture, their presentation, evolution and current management. ⋯ Prevention is essential regarding Volkmann's ischaemic contracture. This can be achieved through careful observation of patients sustaining high-risk extremity injuries, notably, children with supracondylar fractures of the humerus, and immediate decompression if signs and symptoms of a compartment syndrome are present. Increased awareness amongst doctors of compartment syndrome is fundamental and will allow early recognition, clinical diagnosis and subsequent fasciotomy.
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Eur J Trauma Emerg S · Apr 2012
Causes of inpatient death for patients with warfare-related limb trauma and logistic regression analysis of the risk factors.
To explore the causes and risk factors of inpatient death for patients with warfare-related limb trauma. ⋯ The primary cause of death from warfare-related limb trauma is ARF. The appropriate and prompt management of shock patients, the correct timing of amputation, and the prevention and correct handling of infection are important in reducing mortality.
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Eur J Trauma Emerg S · Apr 2012
Emergency thoracotomies in the largest trauma center in Denmark: 10 years' experience.
The aim of our study was to investigate the outcome in terms of 30-day survival and to determine whether preoperative factors could predict the outcome. ⋯ The probability of survival and ISS are good predictors of survival in these patients and should be included in the future in order to make upcoming studies easier to compare. Patients with very high ISS or low probability of survival survived, justifying the procedure in our center.