CME : Your SA Journal of CPD - Volume 22, Issue 7, 2004
Volume 22, Issue 7, 2004
Source: CME : Your SA Journal of CPD 22, pp 369 –372 (2004)More Less
A significant proportion of deaths from thoracic trauma occur virtually immediately (i.e. at the time of injury), for example rapid exsanguination following traumatic rupture of the aorta, or major vascular disruption after penetrating injury. <BR>Of survivors with thoracic injury who reach hospital, a significant proportion die in hospital as the result of mis-assessment or delay in the institution of treatment. These deaths occur early as a consequence of shock, or late as the result of ARDS and sepsis. <BR>Most life-threatening thoracic injuries can be simply and promptly treated after identification, by needle or tube placement for drainage. These are simple and effective techniques that can be performed by any medical practitioner. <BR>Emergency room thoracotomy (ERT) has distinct and specific indications. Indiscriminate use will not alter the morbidity or mortality, but will increase the risk of communicable disease transmission in health workers. <BR>Injuries to the chest wall and thoracic viscera can directly impair oxygen transport mechanisms. The hypoxia and hypoxaemia that results may cause secondary injury, especially to the brain. <BR>Brain injury can secondarily aggravate thoracic injuries by disrupting normal ventilatory patterns. In addition, the lung is a target organ for secondary injury following shock and remote injury.
Interfacility transfer of patients in South Africa - what you need to know and how to make it happen : main topicAuthor Fraser LamondSource: CME : Your SA Journal of CPD 22, pp 374 –377 (2004)More Less
Appropriate choice of patient and appropriate choice of receiving facility is of the utmost importance. The patient must be moved to the nearest appropriate facility for the existing condition or the expected complications to be managed. <BR>Helicopter transport is primarily suited for urgent cases, where road transport is not appropriate, within about a 200 km radius. <BR>Fixed-wing transport is appropriate for longer distances, requiring more controlled conditions. <BR>Where possible, dedicated, pressurised aircraft, operated by reputable, experienced air ambulance staff should be used. <BR>Scheduled services should only be used for the transport of stable patients. The airline involved should be fully appraised of the circumstances and requirements.
Author Graeme J. PitcherSource: CME : Your SA Journal of CPD 22, pp 378 –381 (2004)More Less
Awareness of the spectrum of injury is the single most important factor. <BR>A systemic approach is essential. <BR>Manage acute injuries first according to ATLS principles. <BR>Institute therapy for prevention of transmissible disease and pregnancy. <BR>Collect the necessary forensic evidence. <BR>Manage the social circumstances. <BR>Institute long-term support and rehabilitation.
Source: CME : Your SA Journal of CPD 22, pp 382 –384 (2004)More Less
Extremity fractures are caused by either low- or high-energy forces and may be isolated or combined with other injuries. When the underlying fracture is associated with a cutaneous wound, prevention of wound sepsis remains the primary objective in wound management. <BR>These wounds require emergency treatment as soon as possible (within 6 hours). <BR>Expectation of compartment syndrome, and its avoidance or treatment are critical. <BR>Appropriate antibiotic prophylaxis is not a substitute for appropriate wound management. <BR>With grade III fractures, multidisciplinary management is essential.
Author Frank PlaniSource: CME : Your SA Journal of CPD 22, pp 388 –390 (2004)More Less
Author A. OkreglickiSource: CME : Your SA Journal of CPD 22, pp 398 –399 (2004)More Less
Narrow QRS complex tachycardias are SVTs. <br>If irregular, consider AFib. <br>If regular and not ST or obvious atrial flutter, perform a vagal manoeuvre or give adenosine. <br>If the SVT terminates, it is an AV junction-dependent tachycardia. <br>If the SVT slows with some degree of AV block, underlying atrial tachycardia or atrial flutter will be revealed. <br>Many regular SVTs are curable by ablation therapy and therefore should be referred. <br>In these 2 arrhythmias, ablation therapy is not only the treatment of choice but now considered first-line therapy as it is curative and obviates long-term drug control.