International journal of critical illness and injury science
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Int J Crit Illn Inj Sci · Jul 2016
Controlling hemorrhage in exsanguinating pelvic fractures: Utility of extraperitoneal pelvic packing as a damage control procedure.
Exsanguinating pelvic fractures are still associated with a significant mortality rate of 28-60%. Extraperitoneal pelvic packing (EPP) has been proposed as an optimal method of early haemorrhage control. The aim of this study was to determine the effect of EPP compared with angioembolization as a primary intervention for patients with exsanguinating pelvic fracture. ⋯ EPP appears to be a safe and efficient technique for primary haemorrhage control in exsanguinating pelvic fractures. Given the high rate of associated arterial injury, EPP should be considered as the first part of a "damage control" approach for exsanguinating pelvic fractures.
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Int J Crit Illn Inj Sci · Jul 2016
Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital.
Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. ⋯ Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.
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Int J Crit Illn Inj Sci · Apr 2016
Comparison of effectiveness of class lecture versus workshop-based teaching of basic life support on acquiring practice skills among the health care providers.
Basic life support (BLS) is an integral part of emergency medical care. Studies have shown poor knowledge of it among health care providers who are usually taught BLS by lecture-based teachings in classes. ⋯ Workshop-based BLS teaching is more effective and lecture-based class teaching better is replaced in medical education curriculum.
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Int J Crit Illn Inj Sci · Apr 2016
A comparison of ketamine versus etomidate for procedural sedation for the reduction of large joint dislocations.
Ketamine and etomidate are used for procedural sedation (PS) to facilitate the performance of painful procedures. We hypothesized that ketamine produces adequate and comparable sedation conditions for dislocated large joint reduction when compared to etomidate and results in fewer adverse events. ⋯ Ketamine produces PS conditions for successful large joint dislocation reduction that are adequate and comparable to etomidate. The increased likelihood of myoclonus, of the requirement for airway assistance, and of hypoxia observed with etomidate suggest potential benefits with the utilization of ketamine for PS for dislocated large joint reduction.
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Int J Crit Illn Inj Sci · Jan 2016
What happens to the hemodynamic responses for laryngeal mask airway insertion when we supplement propofol with butorphanol or fentanyl for induction of anesthesia: A comparative assessment and critical review.
There is a delicate balance between respiratory tract anatomy, its physiology, physiological response to anesthetic agents, and airway management. The traditional gadgets to secure airway are face masks or endotracheal tubes. Recently, laryngeal mask airway (LMA) is gaining popularity. It does not require laryngoscopy thereby minimizing hemodynamic responses. For LMA placement, propofol is the induction agent of choice. Propofol, when used alone, requires large doses and leads to undesirable cardiorespiratory depression. To culminate its dose, various adjuncts are combined with it. ⋯ The use of propofol-butorphanol combination produces stable hemodynamics as compared to propofol-fentanyl combination.