BMC emergency medicine
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BMC emergency medicine · Jan 2012
Clinical validation of S100B use in management of mild head injury.
Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients. ⋯ The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.
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BMC emergency medicine · Jan 2012
Review Randomized Controlled TrialAvoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial.
The CRASH-2 trial showed that early administration of tranexamic acid (TXA) safely reduces mortality in bleeding in trauma patients. Based on data from the CRASH-2 trial, global mortality data and a systematic literature review, we estimated the number of premature deaths that might be averted every year worldwide through the use of TXA. ⋯ The use of TXA in the treatment of traumatic bleeding has the potential to prevent many premature deaths every year. A large proportion of the potential health gains are in low and middle income countries.
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BMC emergency medicine · Jan 2012
Randomized Controlled Trial Multicenter StudyA multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2).
Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. ⋯ The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group.
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BMC emergency medicine · Jan 2012
Randomized Controlled TrialNovel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial.
Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study's purpose was to determine the efficacy of three novel CPR refreshers--online website, e-mail and text messaging--for improving three outcomes of CPR training--skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered "novel" in that they are not typically used to refresh CPR knowledge and skills. ⋯ There was no consistent evidence for the superiority of novel refreshers as compared with a traditional mailed brochure, but the low degree of actual exposure to the materials does not allow a definitive conclusion. An online web-based approach seems to have the most promise for future research on electronic CPR refreshers.
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BMC emergency medicine · Jan 2012
Case ReportsIdentical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series.
In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar.During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. ⋯ From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS).