Scand J Trauma Resus
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This paper describes a simple approach to emergency burr hole evacuation of extra-axial intracranial haematoma that can be used in the uncommon situation when life saving specialist neurosurgical intervention is not available.
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Scand J Trauma Resus · Oct 2011
Editorial CommentTrauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival.
Trauma is a major--and increasing--cause of death, especially in low- and middle income countries. In all countries rural areas are especially hard hit, and the distribution of physicians is skewed towards cities. ⋯ Researchers in these countries need support and collaboration from their peers in industrialized countries. This partnership will be of mutual benefice.
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Scand J Trauma Resus · Jan 2011
EditorialUnanswered questions in the use of blood component therapy in trauma.
Recent advances in our approach to blood component therapy in traumatic hemorrhage have resulted in a reassessment of many of the tenants of management which were considered standards of therapy for many years. Indeed, despite the use of damage control techniques, the mortality from trauma induced coagulopathy has not changed significantly over the past 30 years. More specifically, a resurgence of interest in postinjury hemostasis has generated controversies in three primary areas: 1) The pathogenesis of trauma induced coagulopathy 2) The optimal ratio of blood components administered via a pre-emptive schedule for patients at risk for this condition, ("damage control resuscitation"), and 3) The appropriate use of monitoring mechanisms of coagulation function during the phase of active management of trauma induced coaguopathy, which we have previously termed "goal directed therapy". Accordingly, recent experience from both military and civilian centers have begun to address these controversies, with certain management trends emerging which appear to significantly impact the way we approach these patients.
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Scand J Trauma Resus · Jan 2011
EditorialThe 'off-hour' effect in trauma care: a possible quality indicator with appealing characteristics.
A recent paper has drawn attention to the paucity of widely accepted quality indicators for trauma care. At the same time, several studies have measured whether mortality of trauma patients changes between normal working time and other parts of the day/week, i.e. the so-called 'off-hour' or 'weekend' effect. ⋯ As an outcome indicator it would not need validation, a procedure particularly difficult in trauma care where gathering scientific evidence is more difficult than in other disciplines. As a process indicator it would provide indications about where to intervene to improve quality.
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Scand J Trauma Resus · Jan 2011
EditorialHemostatic resuscitation for acute traumatic coagulopathy.
Trauma resuscitation paradigms have changed considerably over the last twenty years. Originally, the goal was to normalize a blood pressure as quickly as possible. Large volume crystalloid resuscitation was used to accomplish this. ⋯ Fresh frozen plasma and platelets were also used relatively late, often after patients had received ten units of red cells. Dilutional anemia was relatively common. Patients with large volume blood loss often died from what was termed, "the bloody vicious cycle," of hypothermia, acidosis and coagulopathy.