Cases reported "Multiple Trauma"

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1/15. Massive prehospital transfusion in multiple blunt trauma.

    A 15-year-old male passenger in a motor vehicle accident was transfused 15 units of blood products and 8.5 litres of polygeline while still trapped in the wreckage. This and other advanced interventions at the scene contributed to the patient's survival. This first case report of massive prehospital transfusion highlights some of the advantages of senior physician staffed emergency medical services in the prehospital phase of trauma management.
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2/15. Treatment of casualties of military conflicts at the Critical medicine Clinic of the Central Hospital in georgia.

    INTRODUCTION: Local military conflicts continue in many areas of the world. These conflicts produce multiple casualties to military personnel and civilians. This paper describes one aspect of the medical care required for victims of the civil conflict in the Republic of georgia. methods: Interviews with patients and their accompanying persons and abstraction of medical records. RESULTS: Data were acquired on 108 victims admitted to the Center for Critical medicine in Tbilisi. Three stages in the care of these victims are described: 1) battlefield and transportation; 2) regional, front-line hospitals; and 3) the Central Hospital. The performance of each stage is described. Distribution of injuries and procedures performed in the third stage of treatment are described and survivors are defined. For illustration, two cases are reviewed in detail. CONCLUSIONS: The results are encouraging. Major problems existed in the treatment and evacuation of the wounded. Furthermore, many of the victims were injured because of their carelessness and lack of experience on the battlefield.
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ranking = 0.46031155537347
keywords = transport
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3/15. British-Czech co-operation in a mass casualty incident, Sipovo. From aeromedical evacuation from Bosnia to discharge from Central Military Hospital, Prague.

    On Thursday 8 January 1998, a Czech hip helicopter with 21 personnel on board crashed in Bos Krupa, northwest Bosnia, resulting in one of the largest mass casualty incidents involving peacekeepers in Bosnia since conflict broke out there in 1992. Seventeen patients were airlifted from the scene to the British Hospital Squadron in Sipovo, central Bosnia for resuscitation and initial treatment. The next day, six severely injured patients underwent aeromedical evacuation to the Central Military Hospital in Prague. The role of the British Defence Medical Services in this incident was documented in the first article of this two part series. This second article highlights the role of the Czech medical services following aeromedical evacuation of these six patients, and closes the audit trial by documenting the patients' progress and final outcome in Prague.
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4/15. Multivascular trauma on an adolescent. Perioperative management.

    Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray. As the patient was cardiovascularly unstable he was immediately transported to the theater without any angiography. The mandatory operative exploration was initially unsuccessful and a median sternotomy with a standard cardiopulmonary bypass and deep hypothermia circulatory arrest was established to restore all the vascular lesions. Actually, the patient was in critical condition with a rupture of the right internal jugular vein, a large pseudoaneurysm of the innominate artery and an avulsion of the ascending aorta with the suspicion of a cardiac tamponade. The postoperative period lasted two full months, while complications appeared. The substantial message from this multivascular trauma is the early diagnosis of the life-threatening complications as exsanguinations, ventricular fibrillation and the ability to minimize postoperative complications, which will impair the normal functional life of the patient.
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ranking = 0.46031155537347
keywords = transport
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5/15. hospitals without walls: a journey through the health-care system.

    The paper describes aspects of a journey through the health-care system following a domestic accident. The journey commenced in the accident and emergency department and, over a 3 month period, traversed the operating theatre, intensive care and an orthopaedic ward before moving into a Hospital in the Home programme and community health and district nursing services. The paper explores the experiences of the accident victim, a 56-year-old man, and his wife who is an experienced nurse and university lecturer. The paper supports the 'seamless delivery' concept of integrated care while, at the same time, sounding notes of caution. The principal messages in this paper are about the relationships that nurses build with patients and their families over long periods of care, the paradoxical sense of 'outsideness' that can occur when the home becomes medicalized and the importance of the home as a healing environment.
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6/15. Importance of early identification of methylenedioxymethamphetamine ('ecstasy') ingestion in victims of motor vehicle accidents.

    The blood of motor vehicle accident victims is routinely screened upon their arrival at the emergency services mainly for alcohol, unless the suspicion of a specific compound arises. Two young men who sustained severe internal and orthopaedic injuries after a motor vehicle accident are described. The conscious patient denied their having used stupefacients, but toxicological analysis upon arrival at the operating room detected methylenedioxymethamphetamine, the metabolite methylenedioxyamphetamine and methamphetamine in their blood and urine specimens. Methylenedioxymethamphetamine concentrations in the clotted blood and in the urine ranged between 0.9-1.15 and 55-70 mg/l, respectively. Methylenedioxyamphetamine concentrations for both patients were less than 0.2 mg/l in the blood and 2.0-3.0 mg/l in the urine. Each had a blood methamphetamine concentration greater than 250 ng/ml. There was no trace of alcohol. Three days after their arrival at the hospital, acute liver insufficiency and mild rhabdomyolysis (serum glutamate-pyruvate transaminase/serum glutamic-oxaloacetic transaminase 1245/218 mU/ml, creatine phosphokinase 48 000 U/ml, respectively) were diagnosed in both patients. Appropriate treatment was administered in an intensive care area and both were discharged home several weeks later without sequelae. These findings suggest that in this era of the widespread abuse of 'ecstasy', concentrations of methylenedioxymethamphetamine, methylenedioxyamphetamine or metamphetamine should be sought routinely in motor vehicle accident victims admitted to emergency services with an altered state of consciousness so that the early monitoring of the potential development of organ pathology can be implemented.
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7/15. ARDS with severe hypoxia--aeromedical transportation during prone ventilation.

    Severe hypoxia, despite maximal conventional respiratory support, is one of the few remaining limitations to aeromedical transportation. A case of a 35-year-old female, who was referred 36 hours following major trauma for transfer by air to a tertiary center, is presented. At the time of referral the PaO2/FiO2 ratio was 48. Usual manoeuvres to improve oxygenation had only minimal impact. The patient was turned and subsequently transported prone with resultant improvement in PaO2/FiO2 ratio to 260. There were no patient- or transport-related adverse events. The implication of prone positioning during aeromedical transportation is discussed.
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ranking = 3.6824924429878
keywords = transport
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8/15. Complex pain consultations in the pediatric intensive care unit.

    The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.
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9/15. Considerations in the aeromedical evacuation of a critically ill blast victim: lessons learned.

    Rationale for the decision to transport and assessment of available resources are integral components of the decision for aeromedical evacuation of critically ill patients. We present the case of a 20-year-old man who sustained significant trauma after his vehicle struck a land mine. This case reviews and emphasizes the factors to consider in arriving at the decision to transport as well as the accurate assessment of available equipment and personnel resources.
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ranking = 0.92062311074694
keywords = transport
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10/15. Preclinical and clinical care of extremity lesions in polytraumatized patients.

    The first and principal aim of the preclinical care of polytraumatized patients is preserving life through the restoration of respiration and circulation. Following this, the external hemorrhages should be treated. Early reduction of closed and open fractures relieves the pressure on the skin and surrounding soft tissues and prevents secondary transport-damage. immobilization of the fractures, together with the proximal and the distal joints in a pneumatic splint, is carried out before transport. During the clinical phase, the operative stabilization of the fractures follows reanimation and life-saving operations. Primary treatment is performed as far as possible, because it reduces late death due to sepsis and multiorgan failure. In case of several fractures, an order of treatment is set up: fractures with an arterial lesion, second or third-degree open fractures and fractures with an impending compartment syndrome are the most urgent. The principles of fracture treatment in elective surgery are also valid for emergency osteosynthesis, but the choice of the fixation-device can be different. The external fixation is the first-choice treatment for fractures of the lower leg, while plate osteosynthesis is preferred for femur and humerus.
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ranking = 0.92062311074694
keywords = transport
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