Articles: trauma.
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Eur J Trauma Emerg Surg · Feb 2014
Fast Track by physician assistants shortens waiting and turnaround times of trauma patients in an emergency department.
We sought to determine whether the introduction of a separate patient flow comprising patients with simple, non-complex health issues [Fast Track (FT)] in a Dutch emergency department setting (ED), without the introduction of additional staff, and treated by a physician assistant, would have favourable effects on waiting and turnaround times without deleterious effects for patients with a higher urgency. ⋯ The introduction of FT performed by a physician assistant resulted in a significant drop in waiting time and length of stay in a Dutch ED setting. This reduction was realised without the allocation of additional staff and even reduced waiting and turnaround times for the patients with a high urgency.
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Despite the abundance of evidence to the contrary, 6-8 hours of total preoperative fasting is still considered essential by many surgeons and anesthesiologists, based on the strength of old concepts. Patients frequently end up fasting for 12 hours or more because of delays and changes in operating room schedules. ⋯ In fact, there has not been any evidence indicating that a shorter fast of 2-3 hours, which includes oral clear or carbohydrate (CHO)-rich (12.5% carbohydrates, 50 kcal/100 mL) fluids, results in an increased risk of aspiration, regurgitation, or related morbidity compared with the standard policy of "nil by mouth after midnight." In addition, preoperative treatment with CHO-rich fluids may reduce postoperative discomfort and, for patients undergoing major abdominal surgery, may decrease the duration of postoperative hospitalization. New formulas for preoperative oral fluids containing amino acid or protein such as glutamine or whey protein are also potential candidates for early preoperative treatment and merit further study.
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The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP). ⋯ These data do not suggest any advantage to the routine use of US localization for LP insertion, although further study may be warranted to look for benefit in the difficult to palpate or obese patient subgroups.
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The probability of survival (PS) in blunt trauma as calculated by Trauma and Injury Severity Score (TRISS) has been an indispensable tool in trauma audit. The aim of this study is to explore the predictive performance of the latest updated TRISS model by investigating the Age variable recategorisations and application of local Injury Severity Score (ISS) and Revised Trauma Score (RTS) coefficients in a logistic model using a level I trauma centre database involving Asian population. ⋯ The present study has demonstrated that (1) having the Age variable being dichotomised (cut-off at 55 years) as in the eTRISS, but with the application of a local dataset-derived coefficients give better TRISS survival prediction in Asian blunt trauma patients; (2) improved performance are found with certain recategorisation of the Age variable and (3) the accuracy can further be enhanced if the Age effect is taken to be linear, with the application of local dataset-derived coefficients.
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We review the English literature between 1980 and 2013 and summarize the clinical classification, aetiology, physiology, and pathophysiology of paediatric priapism. We propose a clinical guideline for the management of priapism in children. ⋯ Priapism in children must be assessed urgently. Rapid resolution of ischaemic priapism prevents permanent cavernosal structural damage and is associated with improved prognosis for potency later in life. Stuttering priapism requires careful counselling for episodic management. Chronic prophylaxis may be obtained using α-adrenergic sympathomimetics, phosphodiesterase type 5 inhibitors and, in sickle cell disease, hydroxyurea. Non-ischaemic and neonatal priapism may generally be treated less urgently.