Emergency Thoracotomy Saves Lives in a Scandinavian Hospital Setting.

BACKGROUND:: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times. METHODS:: One hundred and nine consecutive ET performed in our emergency department during a 6-year period were analyzed. Data were drawn from the hospital's trauma registry. Demographics, mechanism of injury, anatomic injuries, physiologic status, interventions, time lapse, and outcome 30 days after injury were registered prospectively. RESULTS:: Ten of 27 patients with penetrating (37%) and 10 of 82 patients with blunt injuries (12%) survived, giving a total survival of 18%. Median (quartiles) for the following parameters were Injury Severity Score 38 (26-50), Revised Trauma Score 1.3 (0-3.9), Glasgow Coma Scale score 3 (3-6), and probability of survival 0.06 (0.001-0.22). Survivors from penetrating injuries had significantly lower Injury Severity Score (25 vs. 34, p = 0.003), higher Revised Trauma Score (3.92 vs. 0.00, p < 0.001), higher Glasgow Coma Scale score (8 vs. 3, p < 0.001), and higher probability of survival (0.74 vs. 0.01, p < 0.001) than nonsurvivors. Conversely, no such differences were found for patients with blunt injury. Multiple logistic regression analysis failed to reveal any predictors of survival. CONCLUSION:: An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient

Vaginal vask før keisersnitt for å forebygge postoperativ endometritt

Keisersnitt er den viktigste risikofaktoren for å utvikle postpartum endometritt, en komplikasjon som forlenger den postoperative tilhelingen og kan forstyrre etableringen av mor-barn-relasjonen i nyfødtperioden, samt i noen tilfeller ha et alvorlig forløp. Cochrane-samarbeidet har publisert systematiske oversikter som anbefaler antibiotikaprofylakse og vaginal desinfeksjon som infeksjonsforebyggende tiltak ved keisersnitt. Mens profylaktisk bruk av antibiotika er i varierende grad av bruk i norsk klinisk praksis, er det liten oppmerksomhet rundt preoperativ vaginal desinfeksjon. Vi tok for oss innføring av sistnevnte som kvalitetsforbedring