Determining surgical surge capacity with a hybrid simulation exercise.

Background: To help test and improve surgical surge capacity, mass casualty incident (MCI) exercises generate valuable information. Both large scale table-top exercises (TTX) and full-scale exercises (FSX) have limitations if you want to test an organisation's capability and structure. A hybrid exercise incorporating the advantages of TTX and FSX is a possible way forward, but is no standardised exercise method, yet.

Determining the educational impact of virtual patients on trauma team training during a multinational, large-scale civil military simulation exercise.

Background: With asymmetrical conflicts ongoing, many countries have an increasing number of major trauma events but limited capacity to cope with these events. Training for such events comprises primarily of simulations requiring significant resources and that are time-consuming and expensive. Virtual patients are defined as computer-based programs presenting authentic cases support training in trauma management.

Teams managing civilian and military complex trauma: What are the competencies required in austere environments and the potential of simulation technology to address them?

Surgical training in civilian hospitals may not be sufficient for managing complex trauma in a setting where such care is not commonly practiced. Understanding the challenges that civilian teams face when moving to austere environments can inform the competencies that need to be trained. The aim of this study was to explore the competencies required in austere environments for teams managing complex trauma, and how they can be trained with simulation technologies.

Swedish emergency hospital surgical surge capacity to mass casualty incidents.

Background: In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals.

Haemodialysis for post-traumatic acute renal failure - factors predicting outcome.

Background: Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality.

Objective: To assess indicators of improved survival.

Methods: This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) who underwent haemodialysis (HD) over a period of 5 years.

Selective non-operative management of abdominal gunshot wounds: survey of practise.

Background: There is a growing body of evidence attesting to the effectiveness and safety of selective non-operative management (SNOM) of abdominal gunshot wounds. However, much of the research which supports this conclusion has originated from a few centres, and the actual utilisation of SNOM by trauma surgeons is not known. We therefore conducted a survey to assess the acceptance of this strategy and evaluate variations in practise.

Antimicrobial susceptibility of gram-negative pathogens isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004-2009): impact of the new carbapenem breakpoints.

Background: The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world.

Methods: During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospitals in three large South African cities collected 1,218 GNB from complicated intra-abdominal infections (cIAIs) and tested them for susceptibility to 12 antibiotics according to the 2011 Clinical Laboratory Standards Institute (CLSI) guidelines.

Results: Enterobacteriaceae comprised 83.

[24 hours at Johannesburg Hospital Trauma Unit].

This paper describes the hectic work as a doctor at the Trauma Unit of Charlotte Maxeke Johannesburg Academic Hospital, a highly regarded and well-visited trauma unit worldwide. A trauma junior doctor is followed on a 24-hour-call through a full casualty to urgent operations and complicated postoperative management of the trauma patient. In a diary fashion the paper describes the evidence-based guidelines of management of certain trauma cases brought into the trauma unit during the 24-hour-shift.

Prolonged prothrombin time after recombinant activated factor VII therapy in critically bleeding trauma patients is associated with adverse outcomes.

Background: In trauma patients with significant hemorrhage, it is hypothesized that failure to normalize prothrombin time (PT) after recombinant activated factor VII (rFVIIa) treatment predicts poor clinical outcomes and potentially indicates a need for additional therapeutic interventions.

Methods: To assess the value of PT to predict outcomes after rFVIIa or placebo therapy, we performed a post hoc analysis of data from 169 severely injured, critically bleeding trauma patients who had 1-hour postdose PT measurements from two randomized clinical trials. Baseline characteristics and outcome parameters were compared between subjects with 1-hour postdose PT >or=18 seconds and PT <18 seconds.

The treatment of bleeding is to stop the bleeding! Treatment of trauma-related hemorrhage.

Background: The secret with any alternative to transfusion is to minimize the need for transfusion in the first place. This can be done by reducing the volume of blood loss. The volume of blood being lost can be reduced by direct methods where possible (i.

Who was William Ray Rumel?

This report details the life and contributions of William Ray Rumel, an early cardiovascular surgeon known for his innovations, particularly the "Rumel tourniquet," and the ability to repair the diseased mitral valve without replacing it.

Cost-Effectiveness of Recombinant Activated Factor VII as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients in Germany.

Purpose: The purpose of this study was to assess the cost-effectiveness of recombinant activated factor VII (rFVIIa) as adjunctive therapy for the control of bleeding in patients with severe blunt trauma injuries in Germany. The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained.

Materials And Methods: We developed a cost-effectiveness model based on patient-level data from a 30 day international, randomized, placebo-controlled phase II trial.

Safety of rFVIIa in hemodynamically unstable polytrauma patients with traumatic brain injury: post hoc analysis of 30 patients from a prospective, randomized, placebo-controlled, double-blind clinical trial.

Background: Trauma is a leading cause of mortality and morbidity, with traumatic brain injury (TBI) and uncontrolled hemorrhage responsible for the majority of these deaths. Recombinant activated factor VIIa (rFVIIa) is being investigated as an adjunctive hemostatic treatment for bleeding refractory to conventional replacement therapy in trauma patients. TBI is a common component of polytrauma injuries.

Resuscitation and anaesthesia for penetrating trauma.

Purpose Of Review: The worldwide burden of trauma is increasing, but is unequal between nations. Trauma targets the young and productive in society and imposes a major burden on the health infrastructure. This review provides a distillation of practice in a busy urban trauma centre dealing with large volumes of penetrating trauma.

Pharmacokinetics of recombinant activated factor VII in trauma patients with severe bleeding.

Introduction: Recombinant activated factor VII (rFVIIa) has been used as adjunctive therapy in trauma patients with severe bleeding. However, its pharmacokinetics profile remains unknown.

Methods: In two placebo-controlled studies in patients with blunt and penetrating trauma, the pharmacokinetics of rFVIIa given at an initial dose of 200 microg x kg-1 after transfusion of eight red blood cell units, followed by additional doses of 100 microg x kg-1, one and three hours later, have been studied, based on the FVII coagulant activity assay.

The use of low dosage X-ray (Lodox/Statscan) in major trauma: comparison between low dose X-ray and conventional x-ray techniques.

Background: Patients presenting with major trauma normally require resuscitation, usually carried out according to techniques laid down by the Advanced Trauma Life Support (ATLS) Program of the American College of Surgeons. Techniques normally suggested include the routine radiology of the cervical spine, chest and pelvis. This can sometimes be time consuming and may not return helpful information in all cases.

Intraoperative blood salvage in penetrating abdominal trauma: a randomised, controlled trial.

Background: Blood is a scarce and costly resource. Transfusion is often required after major trauma but blood may not be readily available, and concerns remain over the potential adverse consequences of allogeneic blood transfusion. Intraoperative blood salvage (IBS) is used extensively after blunt abdominal trauma, but when blood is contaminated by enteric contents its use has been considered contraindicated.

Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.

Background: Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma.

Methods: Severely bleeding trauma patients were randomized to rFVIIa (200, 100, and 100 microg/kg) or placebo in addition to standard treatment.

Substance abuse and major trauma in Johannesburg.

Introduction: The abuse of alcohol and drugs is a major public health problem and intoxication is one of the most important risk factors for violence and other causes of injury. The aim of the current study was to evaluate the prevalence of drug and alcohol use associated with injury in adult trauma patients in an inner city trauma unit in Johannesburg.

Methods: A cohort of 105 adult trauma patients admitted to our university trauma unit and its allied medicolegal laboratory were studied in order to provide prospective data and enable us to correlate the prevalence and type of substance abuse with the demographics and injury patterns after major trauma.