Isr Med Assoc J
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Pelvic fracture is a severe and life-threatening injury that requires treatment by a dedicated team. One of the goals of a nationwide trauma system is to provide appropriate medical care for such injuries. ⋯ Our results show a more than twofold increase in the percentage of referred patients following the designation of a Level I trauma center. These referrals are due not only to the designation as a Level I trauma center, but also to the presence of a dedicated team of pelvic fracture specialists, available 24 hours a day. In addition, a larger percentage of patients undergo surgery for internal fixation of pelvic fractures, in accordance with current worldwide trends.
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The Pediatric Advanced Life Support course of the American Heart Association/American Academy of Pediatrics was established in Israel in 1994 and has since been presented to over 3,108 medical and paramedical personnel. ⋯ PALS was successfully delivered to a large number of healthcare providers in various professional groups with very good overall achievements and high participant satisfaction. It significantly increased participants' knowledge of pediatric resuscitation. We therefore recommend the PALS course as an educational tool in Israel.
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Although 40 years have passed since the advent of advanced cardiac life support, out-of-hospital cardiac arrest still carries an ultimate failure rate of 95%. This review reinforces the importance of public education, optimization of the local chain of survival, early bystander access and bystander basic life support, and early defibrillation. ⋯ The impact of automatic external defibrillators and new medications incorporated into ACLS algorithms is evaluated in the light of contemporary research. The persistent, discouraging, low functional survival rate (less than 5% of out-of-hospital cardiac arrest victims) mandates reassessment of current strategies and guidelines.
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Despite many published retrospective analyses on cardiac injuries in treated patients, there is a striking scarcity of population-based studies that include autopsies. ⋯ Given that only a very low percentage of the patients who sustain cardiac injury reach hospital alive, population-based studies, especially autopsy results, should be conducted to define the characteristics of cardiac injuries.
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Many emergency departments use coagulation studies in the evaluation of patients with suspected acute coronary syndromes. ⋯ Abnormal coagulation test results in patients presenting with suspected ACS are rare, they can usually be predicted by history, and they rarely affect management. Routine coagulation studies are not indicated in these patients.