Ve the outcome of major trauma even in absence of a
Ve the outcome of major trauma even in absence of a well-designed trauma system. Methods Retrospective evaluation of the impact on outcome of a standardized approach to the trauma patients admitted to a general ICU in an 450-bed hospital not designated as a trauma center. The interventions adopted were the following: ?Specific training of all the physicians and the nurses involved in the trauma care in the Emergency Department and the ICU. ?Formal adoption of the team approach for trauma patients and of specific guidelines for the diagnostic and therapeutic pathway in the Emergency Department. ?Agreement between the prehospital and inhospital trauma teams on the clinical and dynamic criteria used to alert the trauma team in the field. ?Formal adoption of specific therapeutic protocols for the trauma patient in the ICU. ?The data of 1 year of activity, before, during and after the interventions, were collected and analyzed with the chi-square test. Results There was an increase of the number of patients from 44 to 69 and 66 per year without differences in the mean age (38.8 ?21.6, 38.2 ?18.8 and 42.2 ?22.6 years) and severity scores (SAPS II: 30.2 ?14.2, 31.4 ?14.3, 31.4 ?12.8; ISS: 29.2 ?12.1, 28.2 ?12.0, 29.6 ?11.9), respectively, in 2003, 2004, and 2005. There was a progressive increase of the use of some therapeutic techniques, such as FAST and the CT study of the C-spine in the Emergency Department and non-invasive ventilation and ultrafiltration in ICU. The mortality showed a reduction from 36.3 in 2003 to 24.6 in 2004 and 17.2 in 2005, with a statistically significant difference between 2003 and 2005 (P = 0.034). Conclusion A reorganization of the response of the hospital to the trauma could improve the outcome even in the absence of a trauma system and a high volume of PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/25636517 activity. Reference 1. Biffl WL: J Am Coll Surg 2005, 200:922-929.P136 New shape of battle casualty with effects of body armorE Peytel, A Nau, A Puidupin, C Drouin, J Carpentier H ital d’instruction des arm s Laveran, Marseille, France Critical Care 2006, 10(Suppl 1):P136 (doi:10.1186/cc4483) Background Common use of body armor (BA) and kevlar helmets by soldiers has lead to a change in war penetrating injuries. Methods From 2002 to 2005, the anaesthesiologist and surgical staff of the Military Hospital Laveran, Marseille, France, participated in the combat support hospital for an international task force during peacekeeping operations in Kosovo, Afghanistan and Ivory Coast. Prospective data were collected on all combat casualties affecting wounded soldiers equipped with BA. Results One hundred and sixteen wounded soldier cases wearing BA were included. The incidence of bullet wounds was 2 , of shell/rockets was 47 , of fragments of grenade was 16 , of mines was 6 and of bombing explosions was 29 . Injuries topographically affected the head, groin and neck (23 ), thorax (10 ), abdomen (3 ) and extremities (96 ). Twelve percent died on the battlefield. Eighty-two percent of wounded soldiers reached the medical facility Citarinostat chemical information before 25 ?15 min and were evacuated with a medical team to the combat support hospital in 127 ?65 min between attack and admission; vital emergencies accounted for 17 , including 83 of hemorrhagic shock, 28 of respiratory distress and 11 of coma. After surgical care, the wounded soldiers had strategic medical evacuation to a military hospital in France in PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/26437915 37 ?15 hours. Discussion In the urban battlefield since Sarajevo (1992?996) and Mogadishu.
