Scand J Surg
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The initial management of the poly-trauma patient is of vital importance to minimizing both patient morbidity and mortality. We present a practical approach to the early management of a severely injured patient as practiced at Liverpool Hospital in Sydney, Australia. Specific attention is paid to innovations in care and specific controversies in early management as well as local solutions to challenging problems.
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Colonic or rectal injuries occur in up to 10% of patients that suffer penetrating or severe blunt abdominal trauma. The majority of colon injuries are diagnosed intraoperatively following a penetrating abdominal injury. ⋯ The vast majority of colon injuries can be primarily repaired with a significant trend toward avoiding colostomy whenever possible. Colostomy is increasingly reserved for rectal injuries and destructive colon injuries with extenuating circumstances such as hemodynamic instability and significant associated injuries.
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The early severity assessment of an attack of acute pancreatitis is clinically of utmost importance. The aim of the present work was to study the role of leucocyte count and C-reactive protein (CRP) measurements on admission to hospital in assessing the severity of an attack of acute pancreatitis. In particular, patients with a life-threatening attack of acute pancreatitis but a normal leucocyte count and CRP level were sought. ⋯ It is very unlikely that acute pancreatitis proves to be a life-threatening one when both the leucocyte count and CRP are normal on admission to hospital. In the present 1050 acute pancreatitis there were no patients with life-threatening disease but normal laboratory values on admission.