Basic trauma life support in non-urban setting

Trauma is one of the major causes of mortality and presents a worldwide problem. When approachig a trauma patient on the scene, safety is a priority. The emegency services use anything at their disposal within their range of knowledg to help a trauma patient. It is important to classify the injuries that the patients sustained in order to provide the most effective treatment. Patients that suffered trauma may also experience a traumatic cardiorespiratory arrest. In that case an algorithm for basic life support should be employed. This consists of opening the airway, providing rescue breaths and providing accurate chest compressions. With basic life support, an automated external defibrilator (AED) device can also be used to treat life-threatening arrhythmias related to cardiorespiratory arrest. There are six steps of trauma care, which are triage, primary survey with resuscitation, secondary survey, stabilization, transfer and definitive care. The trauma care can be provided in hospitals designed as trauma centers. Most high level centers are located in urban areas where they can provide all levels of care. Rural (non-urban) areas have lower level trauma centers. Those patients that cannot be cared for at those trauma centers shoud be transferred to a higher level one that is capable of adequately treating their injuries

Basic trauma life support in non-urban setting

Trauma is one of the major causes of mortality and presents a worldwide problem. When approachig a trauma patient on the scene, safety is a priority. The emegency services use anything at their disposal within their range of knowledg to help a trauma patient. It is important to classify the injuries that the patients sustained in order to provide the most effective treatment. Patients that suffered trauma may also experience a traumatic cardiorespiratory arrest. In that case an algorithm for basic life support should be employed. This consists of opening the airway, providing rescue breaths and providing accurate chest compressions. With basic life support, an automated external defibrilator (AED) device can also be used to treat life-threatening arrhythmias related to cardiorespiratory arrest. There are six steps of trauma care, which are triage, primary survey with resuscitation, secondary survey, stabilization, transfer and definitive care. The trauma care can be provided in hospitals designed as trauma centers. Most high level centers are located in urban areas where they can provide all levels of care. Rural (non-urban) areas have lower level trauma centers. Those patients that cannot be cared for at those trauma centers shoud be transferred to a higher level one that is capable of adequately treating their injuries

Our experience with aortic valve repair with a remodeling technique, extraaortic ring implantation and root replacement

Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications.1-3 We would like to present our experience with the Yacoub root remodeling, valve sparing technique with the extraaortic expansible ring. Patients and Methods: Between November 2014 and July 2019, a total of 79 patients (52.6±13.3 years; 15.2% female, EuroScore II of 3.15%±2) underwent AVRep, 12 due to isolated cusp malcoaptation and 67 associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-31)), and the Gelweave graft (28 (26-32)). 44 patients had a tricuspid valve, 33 patients had a bicuspid valve, and 2 patients had an unicuspid valve. Concomitant procedures included Mvrep and TVrep in 4 patients, CABG in two patents. Aortic arch was replaced in two patients, two patients underwent hemiarch replacement, and two patients had aortic arch replacement with stented conduit and placement of stent in descending thoracic aorta (EVITA stent graft Jotec GmbH). Echocardiography was used to determine AR severity grade preoperatively, during immediate post-operative period (within 7 days from operation) and at early follow-up. Results: In postoperative follow-up no patients died. Freedom from reoperation was 88% (10/79) and there were 2 patients reoperated due to early postoperative regurgitation, one patient was reoperated due to AI after two years, and one was operated due to pseudoaneurysm formation after 2.5 years. A significant decrease in LV end-diastolic diameter was observed (LVEDD) (60mm preoperatively, 53 mm postoperatively) with further decrease at early follow-up. At follow up none of the patients had major AR (AR0=61, AR1+=14, AR2+=4). Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDD and LVEF immediately post-operatively and at early follow up. It is feasible to use this technique in tricuspid, bicuspid, as well as unicuspid valves with excellent results