Articles: trauma.
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Despite recent advances, trauma care providers nowadays face a number of coagulopathic patients. Coagulopathy in trauma patients can be secondary to the traumatic insult or therapeutic effect of the anticoagulants including the Vitamin K antagonist. The efficacy of a concentrated product of Vitamin K-dependent coagulation factors, prothrombin complex concentrate (PCC), to reverse coagulopathy has been tested mainly in nontrauma setting. ⋯ There are small studies that show promising results regarding PCC use to reverse the Vitamin K antagonist-related coagulopathy in trauma patients. It remains unanswered whether PCC can be effective as an adjunct in patients who require massive transfusion.
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Eur J Trauma Emerg Surg · Feb 2015
ReviewIntramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits.
External fixation is a safe option for stabilisation of extremity lesions in the polytraumatised patient as well as in fractures with severe soft tissue damage. Nevertheless, long-term-complications are to be expected when external fixation is chosen as a definitive treatment. The purpose of this review article is twofold: primarily, to define the rationale of a procedural change from an external fixator to an intramedullary nail; secondarily, to assess the possible advantages and pitfalls of a single- or two-staged procedure. ⋯ External fixation of the femur is recommended in multiply injured patients who are critically ill to avoid an additional inflammatory response caused by the surgical trauma of primary nailing. The conversion towards nailing must be done as soon as the clinical condition of the patient has been stabilised. Stable polytraumatised patients do not benefit from initial stabilisation with an external fixator and should immediately be treated with a definitive osteosynthesis. In tibial fractures, external fixation followed by intramedullary nailing is recommendable in fractures with severe soft tissue injuries. Conversion should be done as soon as the soft tissues allow before pin-tract infections occur and performed in a one-staged procedure.
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This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. ⋯ Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.
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Review Case Reports
What we know about management of traumatic abdominal wall hernia: review of the literature and case report.
Traumatic abdominal wall hernia (TAWH) is an uncommon form of hernia caused by blunt traumatic disruption of the abdominal wall musculature/fascia and abdominal organ herniation. Diagnosis of TAWH is challenging and requires a high level of suspicion. This form of hernia seems to be underrepresented in the English-language medical literature. ⋯ In this article, we discuss the management of a 36-year-old motorcycle driver who was involved in a road traffic accident. On evaluation at our trauma center, he was found to have TAWH. Diagnostic criteria, imaging modalities and different management options for TAWH will be discussed.
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Concussions are common injuries with increasing diagnostic incidence. The 4th International Conference on Concussion in Sport, held in November 2012 in Zurich, revised consensus statements regarding the definition of a concussion, diagnostic criteria, and management. ⋯ Rhode Island enacted into law the School and Youth Programs Concussion Act in 2010, which increases awareness of concussions for athletes, coaches, teachers, school nurses and parents/guardians through written information and mandatory training for coaches. Athletes must be removed from practice/competition and cannot return until a physician has evaluated and cleared them. [Full text available at http://rimed.org/rimedicaljournal-2015-02.asp, free with no login].