Emergency medicine journal : EMJ
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Case Reports
Emergency surgery in patients in extremis from blunt torso injury: heroic surgery or futile care?
Trauma strikes unexpectedly, frequently in the young and fit. When trauma victims arrive in the emergency room all possible steps, including surgery, are often undertaken in an attempt to achieve a successful outcome. However, for patients presenting in extremis, with cardiac arrest or exsanguinating blunt chest injury, the results of resuscitation and emergency surgery are extremely poor. ⋯ Futile care in the management of severely injured patients is a controversial concept although the literature defines four concepts of futility within surgery. At present, while there remains even the remotest possibility of survival, there remains a strong incentive to act and reports of isolated survivors from studies of trauma patients in extremis or cardiac arrest continue to emerge. This may be seen as justification for either an aggressive surgical approach or an indication that surgery is futile. In an emerging culture of guidelines regarding effectiveness of treatment, is this an area in which such guidelines can or should be applied?
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To determine the timings of regional transfer for emergency neurosurgery and intensive care after severe head injury in children, and the effective operational range of a regional service. ⋯ Good evidence supporting the recommendation that acute neurosurgery for the evacuation of a haematoma within four hours of injury is still scarce. The timings of care after an accident suggest that this guideline is unworkable in regions covering areas with road distance travel times in excess of 45 minutes.
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Comment Letter Comparative Study
Vasopressin or adrenaline in cardiac resuscitation.