The Australian and New Zealand journal of surgery
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John Hunter Hospital is the major trauma centre for a region covering more than 25,000 square kilometres. The helicopter primary retrieval service for trauma is paramedic staffed and protocol driven. The aim of the present study was to assess the overtriage rate created by such protocols, and to assess the benefit to patient outcomes that may be attributable to the service. ⋯ Although the majority of retrievals are for minor injuries, the service provides benefit for the region. There is potential for harm, however, where base hospitals are overflown in situations where patients have airway compromise, and where patient transfer is delayed due to helicopter activation. Primary helicopter tasking to trauma cases within 35 km of the major trauma centre is seldom beneficial.
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Comparative Study
An evaluation of trauma team response in a major trauma hospital in 100 patients with predominantly minor injuries.
A prospective study of trauma team response and performance at a major trauma service was undertaken between June and September 1998. ⋯ The present study identified an excellent multidisciplinary trauma response and provides a template to improve performance in early trauma management.
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The management of splenic injury resulting from blunt trauma in adults is controversial, with an increasing trend towards non-operative management and conservation of the spleen. A retrospective review was performed on adult patients treated in a single institution for splenic injury resulting from blunt trauma in an attempt to identify factors important in selecting an appropriate management option and predicting the success of that option. ⋯ Management of blunt splenic injury remains controversial. The decision to pursue non-operative management rather than splenic conservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic conservation, particularly in younger, stable patients with single organ injury.
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Comparative Study
Pelvic fracture pattern predicts pelvic arterial haemorrhage.
The association between pelvic fracture pattern and the need for pelvic arterial embolization remains controversial. To address this issue, a study of the experience at Auckland Hospital was undertaken. ⋯ The need for pelvic embolization correlated with fracture patterns that indicated major ligament disruption, although the relationship was not sufficiently strong to warrant change to current indications for pelvic angiography.
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The purpose of this study was to review patients treated for penetrating Phoenix date palm injuries. Documentation of the clinical behaviour of these injuries was sought as they have different clinical outcomes to other foreign body injuries. ⋯ Phoenix date palm injuries often have a protracted course. The initial diagnosis and treatment of such injuries is often delayed. Fracturing and fragmentation of the barbs may occur and multiple surgical procedures may be required to remove all of the foreign material. The Phoenix date palm barbs may cause a severe tissue reaction with sterile granulomatous synovitis and bony pseudotumour formation. A high level of suspicion on history taking and surgical exploration is needed. Total synovectomy for delayed joint or tendon sheath involvement may be required when fragmentation has occurred. Ultrasound has higher sensitivity for detection of thorn foreign bodies than magnetic resonance imaging.