Articles: trauma.
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Eur J Trauma Emerg S · Aug 2013
Management of chronic traumatic arteriovenous fistula of the lower extremities.
Vascular injuries secondary to blunt or penetrating trauma are a significant cause of morbidity and mortality, especially in war-afflicted areas. Due to the violent situations of Pakistan and the unavailability of vascular services in remote areas, we are witnessing an increase in the number of delayed/chronic post-traumatic arteriovenous fistulas (AVFs) of the extremities in our institution. The purpose of this study is to share our experience of post-traumatic AVF and the incidence, presentation, and outcomes of these patients. ⋯ Long-standing traumatic AVF is becoming common in Pakistan. Surgery remains the standard treatment.
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Eur J Trauma Emerg S · Aug 2013
Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands.
The classical trimodal distribution of trauma deaths describes three peaks of deaths following trauma: immediate, early and late deaths. The aim of this study was to evaluate whether further maturation of the trauma centre and the improvement of survival have had an effect on the time of death distribution and resulted in a shift in causes of death. ⋯ The temporal distribution of trauma deaths in our hospital changed as maturation of the trauma centre occurred. There is one peak of trauma deaths in the first hour after admission, followed by a rapid decline; no trimodal distribution was observed. Over time, there was a decrease in exsanguinations and an increase of deaths due to CNS injury.
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Hemorrhage remains one of the leading causes of trauma-related deaths. Uncontrolled diffuse microvascular bleeding in the course of initial care is common, potentially resulting in exsanguination. Early and aggressive hemostatic intervention increases survival and reduces the incidence of massive transfusion. ⋯ This strategy addresses important confounders of the coagulation process such as hemodilution, hypothermia, and acidosis; DCR is based on a damage control surgical approach, permissive hypotension, and improvement of hemostatic competence. Many studies have shown benefit in mortality when using high ratios of fresh frozen plasma (FFP) to red blood cells (RBC) as early treatment. However, there is increased awareness that coagulation factor concentrate could be beneficial in the treatment of trauma-induced coagulopathy.
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Otolaryngology (ear, nose, and throat) emergencies are a common complaint in the emergency department. These can present as a result of infection, trauma, foreign bodies, or postprocedure complications. The emergency department physician is called on to offer initial if not definitive management of these patients. This article discusses common ear, nose, and throat emergencies presenting to the emergency department.
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Australas Psychiatry · Aug 2013
ReviewSeeking asylum in Australia: immigration detention, human rights and mental health care.
The article aims to discuss the impact of mandatory detention and human rights violations on the mental health of asylum seekers and the implications for psychiatrists and health professionals. ⋯ Advocacy for human rights and engagement in social debate are core ethical and professional responsibilities. Clinicians need to maintain a focus on ethical obligations.