Correction: Management of bleeding following major trauma: a European guideline

SCOPUS: er.jinfo:eu-repo/semantics/publishe

Management of bleeding following major trauma: an updated European guideline

INTRODUCTION: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. METHODS: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS: Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS: This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Background: Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results: This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion: A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond

Vampires in the village Žrnovo on the island of Korčula: following an archival document from the 18th century

Središnja tema rada usmjerena je na raščlambu spisa pohranjenog u Državnom arhivu u Mlecima (fond: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na događaj iz 1748. godine u korčulanskom selu Žrnovo, kada su mještani – vjerujući da su se pojavili vampiri – oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te rečeni događaj analizira u širem društvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Žrnove on the island of Korčula in Croatia opened tombs on the local cemetery in the fear of the vampires treating. This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions

Fluid resuscitation in controlled and uncontrolled hemorrhage

Background: For many years, early intravenous fluid resuscitation has been widely accepted as an appropriate treatment of the trauma patient at the scene of the injury, regardless of the type of trauma and hemorrhage. The present Thesis describes the effects of fluid resuscitation on the hemodynamics in the presence of a limited controlled hemorraghe and also particularly in the situation when the bleeding is uncontrolled. Methods: I: Eighteen healthy male volunteers were subjected to a 900-mL withdrawal of blood which was replaced with an i.v. infusion of 900 mL of Ringer's solution (n=12) or albumin 5% (n=6); further on, eight of the volunteers receiving Ringer's solution received another 900 mL. II: Thirty-two anesthetized pigs were prepared in such a way as to induce a standardized intra-abdominal vascular aortic lesion in order to evaluate, the spontaneous changes in hemodynamics during and early on after hemorrhage. III. Thirty-two anesthetized pigs were prepared as in study 11 but randomized to receive at 10 min after starting, either no i.v fluid resuscitation or fluid infusion with Ringer's solution in the ratio of 1: 1, 2:1 or 3:1 to the expected blood loss. As in the animal studies IV-VI, the follow-up time was 120 min. IV. Eight anesthetized pigs were prepared as in study III but they received Ringer's solution in the ratio of 3:1 between 10 and 30 min into the study. V. Sixteen anesthetized pigs were prepared as in studies II-IV but were randomized to receive at 10 min after starting, a bolus injection of hypertonic saline/dextran (HSD) amounting to 4 mL/kg and 2.65 mL/kg, respectively. VI. Eight anesthetized pigs were prepared as previously described but also fixed in a missile wound model in order to inflict a standardized high-energy gunshot wound on the thigh in addition to the intraabdominal hemorrhage. Results: I: Withdrawal of 900 mL of blood decreased cardiac output and splanchnic and renal blood flow rates by 16-20%. Autotransfusion of fluid from the extravascular to the intravascular space was indicated by hemodilution. The hemodynamics were better restored with 900 mL of albumin 5% than with 900 mL of Ringees solution. II. The short-term changes in blood flow rates closely follow a simple monoexponential function which makes it possible to express them as half-times (T1/2). Bleeding stops spontaneously after about 3 min. III. During the first 40 min after hemorrhage, compared to baseline, the blood flow rates in the aorta distal to the vascular lesion were 39% (no fluid), 41% (1:1), 56% (2:1), and 56% (3:1), respectively. Rebleeding occurred only when Ringer's solution was infused in the ratio of 2:1 and 3:1. Survival was highest with the 1:1 and 2:1 infusion programs. IV. During the infusion of Ringer's solution between 10 and 30 min after hemorrhage, blood flows, as well as oxygen consumption increased transiently although minor rebleeding episodes during the infusion were observed in three animals. Four animals died in shock. V. The injection of HSD in a bolus injection at 10 min was followed by a prompt increase in all blood flow rates as well as blood pressures. This was closely followed by a rebleeding episode in 13 out of 16 animals and six even had a second episode of rebleeding. Five animals in each treatment group died before the end of the study. VI. The high- energy gunshot wound to the thigh induced instant depressant effects on central hemodynamics which reduced the intra-abdominal bleeding when the aortic vascular lesion was induced. After HSD was injected at 10 min, rebleeding occurred in five animals but the additional blood loss was less than that observed in study V. Conclusions: A controlled hemorrhage of approximately I liter is efficiently compensated for by normal physiological defense mechanisms and rarely needs to be replaced early . In a low-energy trauma with uncontrolled hemorrhage, rebleeding is a serious advent which may occur when fluid resuscitation with Ringer's solution is given in the ratio of 2:1 or 3:1 to the expected blood loss, as well as when HSD is given in a bolus injection. When the trauma is more complicated, hemodynamic mechanisms change, but the risk of rebleeding remains if bleeding is not controlled

Foreign Field Hospitals in the Recent Sudden-onset Disasters in Iran, Haiti, Indonesia, and Pakistan.

NTRODUCTION:Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters.PROBLEM:In the aftermath of sudden-onset disasters, FFHs have been focused on providing emergency trauma care for the initial 48 hours following the sudden-onset disasters, while they tend to be operational much later. In addition, many have remained operational even later. The aim of this study was to assess the timing, activities, and capacities of the FFHs deployed after four recent sudden-onset disasters, and also to assess their adherence to the essential criteria for FFH deployment of the World Health Organization (WHO).METHODS:Secondary information on the sudden-onset disasters in Bam, Iran in 2003, Haiti in 2004, Aceh, Indonesia in 2004, and Kashmir, Pakistan in 2005, including the number of FFHs deployed, their date of arrival, country of origin, length of stay, activities, and costs was retrieved by searching the Internet. Additional information was collected on-site in Iran, Indonesia, and Pakistan through direct observation and key informant interviews.RESULTS:Basic information was found for 43 FFHs in the four disasters. The first FFH was operational on Day 3 in Bam and Kashmir, and on Day 8 in Aceh. The first FFHs were all from the militaries of neighboring countries. The daily cost of a bed was estimated to be US$2,000. The bed occupancy rate generally was < 50%. None of the 43 FFHs met the first WHO/Pan-American Health Organization (PAHO) essential requirement if the aim is to provide emergency trauma care, while 15% followed the essential requirement if follow-up trauma and medical care is the aim of deployment.DISCUSSION:A striking finding was the lack of detailed information on FFH activities. None of the 43 FFHs arrived early enough to provide emergency medical trauma care. The deployment of FFHs following sudden-onset disasters should be better adapted to the main needs and the context and more oriented toward substituting for pre-existing hospitals, rather than on providing immediate trauma care

The bomb attack in Oslo and the shootings at Utøya, 2011 : Kamedo report 97

The Kamedo observer reports study the medical, psychological, organizational and social aspects of disasters. This report summaries experiences from the bomb attack in Oslo and the shootings at Utøya, 2011. That may be valuable for the further development of the Swedish disaster preparedness system.(Article number: 2012-12-23)Co-author and editor: Anders Eklund, Investigator at the National Board of Health and Welfare's Unit for Emergency Preparedness</p

Bombattentatet i Oslo och skjutningarna på Utøya 2011 : Kamedo-rapport 97

Fredagen den 22 juli 2011 kl. 15.25 detonerade en sprängladdning i regeringskvarteret i centrala Oslo. Bomben var mycket kraftig – åtta personer dödades, minst 90 skadades och kringliggande byggnader fick omfattande skador. Senare samma eftermiddag klev en man som utgav sig för att vara polis iland på ön Utøya, där det norska Arbeiderpartiets ungdomsförbund höll ett sommarläger. Väl iland på ön började mannen skjuta omkring sig. När han senare greps av polis hade 69 personer dödats och 65 skadats. De flesta var barn eller ungdomar. Händelserna den 22 juli involverade stora delar av det norska samhället. De många skadade krävde stora insatser från hälso- och sjukvården och det fanns ett stort behov av psykosocialt stöd till de många överlevande och deras anhöriga, samt till de avlidnas anhöriga. Vidare väckte händelserna ett mycket stort medialt intresse som de berörda aktörerna var tvungna att förhålla sig till. Rapporten omfattar en diskussion kring den norska hanteringen av 22 juli 2011,  samt hur det svenska samhället hade kunnat hantera en motsvarande händelse.Tre huvudområden belyses: hälso- och sjkukvård, psykosocialt stöd samt kommunikation och mediehantering.KAMEDO-rapporterna ges ut av Katastrofmedicinska observatörsstudier (KAMEDO) vid Socialstyrelsen. Utsända observatörer studerar de medicinska, psykologiska, organisatoriska och sociala aspekterna av katastrofer. Resultaten med fokus på erfarenheter presenteras i rapporterna.Medförfattare och redaktör: Anders Eklund, utredare på enheten för krisberedskap, Socialstyrelsen</p