European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Apr 2016
Damage control laparotomy and delayed pancreatoduodenectomy for complex combined pancreatoduodenal and venous injuries.
This single-centre study evaluated the efficacy of damage control surgery and delayed pancreatoduodenectomy and reconstruction in patients who had combined severe pancreatic head and visceral venous injuries. ⋯ Damage control laparotomy and delayed secondary pancreatoduodenectomy is a live-saving procedure in the small cohort of patients who have dire pancreatic and vascular injuries. When used appropriately, the staged resection and reconstruction allows survival in a previously unsalvageable group of patients who have severe physiological derangement.
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Eur J Trauma Emerg Surg · Apr 2016
The role of computed tomography in determining delayed intervention for gunshot wounds through the liver.
Gunshot wounds through the liver are highly lethal and are prone to delayed morbidity due to late complications. ⋯ Gunshot wounds to the liver have a high morbidity and mortality rate. Survivors should have a follow-up CT scan performed within 7 days to allow detection and intervention for complications, as this dramatically decreases the overall morbidity rate and length of stay.
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Eur J Trauma Emerg Surg · Apr 2016
Review Practice GuidelineESTES guidelines: acute mesenteric ischaemia.
Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. ⋯ The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
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Eur J Trauma Emerg Surg · Apr 2016
Multicenter Study Observational StudyA multicentre cross-sectional study to examine physicians' ability to rule out a distal radius fracture based on clinical findings.
To study current use of radiography in patients with wrist trauma and examine physicians' ability to rule out a distal radius fracture based on their physical findings. ⋯ Although physicians in the ED are able to accurately discriminate between patients with and without a distal radius fracture based on their physical findings, they were only completely certain of their diagnosis in 19 % of the patients. A validated clinical decision rule could reinforce physician's clinical judgment and support them in their decision not to routinely request radiography.
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Eur J Trauma Emerg Surg · Apr 2016
ReviewOut of hospital point of care ultrasound: current use models and future directions.
Ultrasound has evolved from a modality that was once exclusively reserved to certain specialities of its current state, in which its portability and durability lend to its broadly increasing applications. ⋯ Prehospital ultrasound has the ability to increase diagnostic ability and allow for therapeutic intervention in the field. In austere environments, ultrasound may be the only available imaging modality and thus can guide diagnosis, therapeutics and determine which patients may need emergent transfer to a healthcare facility. The most cutting edge applications of portable ultrasound employ telemedicine to obtain and transmit ultrasound images. This technology and ability to transmit images via satellite and cellular transmission can allow for even novice users to obtain interpretable images in austere environments. Portable ultrasound uses have steadily grown and will continue to do so with the introduction of more portable and durable technologies. As applications continue to grow, certain technologic considerations and future directions are explored.