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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Randomized Controlled Trial Clinical Trial
Peroral tramadol premedication increases postoperative nausea and delays home-readiness in day-case knee arthroscopy patients.
To evaluate the effect of preoperative oral tramadol on postoperative pain and its effect on the patient's home-readiness after diagnostic day-case knee arthroscopy performed under spinal anaesthesia. ⋯ Preoperatively given slow-release tramadol is ineffective for reduction of postoperative pain after day-case arthroscopy of the knee. Additionally, preoperative tramadol is associated with higher incidence of PONV and it seems to cause delay in the patient's home-readiness.
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Historically, penetrating abdominal trauma was managed expectantly until the late 19th century. In World War I, with the high mortality and morbidity associated with penetrating abdominal trauma, operative management replaced expectant management. It was soon realized that not all penetrating abdominal injuries required an operation. ⋯ However, gunshot wounds to the abdomen are still treated by mandatory exploration based on an allegedly high incidence of intra-abdominal injuries and low rate of complications, if laparotomy turns out negative. A number of series have recently surfaced, reporting successful outcomes, while decreasing morbidity and hospital length of stay, with selective non-operative management of gunshot wounds to the abdomen. This review will address the current controversies surrounding selective nonoperative management of gunshot wounds to the abdomen and will present our experience and current approaches.
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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.