This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.sjtrem.com The latest articles from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (ISSN 1757-7241) published by BioMed Central Background: Pre-notification of an arriving trauma patient, given by transporting emergency medical unit, is needed in terms of facilitating the admitting emergency department to get ready for the patient before the patient actually arrives. In the present study we retrospectively analyzed the pre-hospital information provided by 700 consecutive pre-notification mobile phone calls in terms to asses the response of trauma team activation regard to pre-notified information such as vital signs and level of consciousness, mechanism of injury (MOI), and estimated elapsed time (EET) from the time of pre-notification phone call to arrival. Results: The median EET was 15 minutes (range 0 - 80 min, interquartile range 10 - 20 min). In 11% of the cases EET was 5 minutes or shorter. 17 % of the patients were intubated and ventilated on scene at the time pre-notification phone call took place. The most commonly notified pre-hospitally diagnosed injuries were thoracic in 75 cases (11 %), followed by unstable long bone (tibia, femur, humerus) fracture in 66 cases (9 %), and abdominal injuries in 32 cases (5 %). Trauma team was activated for 61 % of 700 pre-notified patients. MOI without clinical symptoms was the reason for team activation in 75 % of the cases. In 25 % of the cases there were pre-hospitally observed clinical injuries or abnormalities in vital parameters. Conclusions: Pre-notification phone call is of a crucial importance in organizing every day activities at a busy trauma centre, but it should not take place in too much advance. In any case, a pre-notification phone call, even on short notice, gives emergency department personnel some time to prepare for the incoming patient. http://www.sjtrem.com/content/16/1/15 Lauri Handolin and Juhapetteri Jaaskelainen Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:15 2008-11-19 doi:10.1186/1757-7241-16-15 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 15 2008-11-19 Isolated non-skeletal injuries of the cervical spine are rare and frequently missed. Different evaluation algorithms for C-spine injuries, such as the Canadian C-spine Rule have been proposed, however with strong emphasis on excluding osseous lesions. Discoligamentary injuries may be masked by unique clinical situations presenting to the emergency physician. We report on the case of a 28-year-old patient being admitted to our emergency department after a snowboarding accident, with an assumed hyperflexion injury of the cervical spine. During the initial clinical encounter the only clinical finding the patient demonstrated, was a burning sensation in the palms bilaterally. No neck pain could be elicited and the patient was not intoxicated and did not have distracting injuries. Since the patient described a fall prevention attempt with both arms, a peripheral nerve contusion was considered as a differential diagnosis. However, a high level of suspicion and the use of sophisticated imaging (MRI and CT) of the cervical spine, ultimately led to the diagnosis of a traumatic disc rupture at the C5/6 level. The patient was subsequently treated with a ventral microdiscectomy with cage interposition and ventral plate stabilization at the C5/C6 level and could be discharged home with clearly improving symptoms and without further complications. This case underlines how clinical presentation and extent of injury can differ and it furthermore points out, that injuries contracted during alpine snow sports need to be considered high velocity injuries, thus putting the patient at risk for cervical spine trauma. In these patients, especially when presenting with an unclear neurologic pattern, the emergency doctor needs to be alert and may have to interpret rigid guidelines according to the situation. The importance of correctly using CT and MRI according to both - standardized protocols and the patient's clinical presentation - is crucial for exclusion of C-spine trauma. http://www.sjtrem.com/content/16/1/14 Timo M Ecker, Mark Kleinschmidt, Luca Martinolli, Heinz Zimmermann and Aristomenis K Exadaktylos Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:14 2008-11-12 doi:10.1186/1757-7241-16-14 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 14 2008-11-12 Background: Serum protein S-100B determinations have been widely proposed in the past as markers of traumatic brain injury and used as a predictor of injury severity and outcome. The purpose of this prospective observational case series was therefore to determine S-100B serum levels in patients with isolated injuries to the back. Material and Methods: Between 1 February and 1 May 2008, serum samples for S-100B analysis were obtained within 1 hour of injury from 285 trauma patients. All patients with a head injury, polytrauma, and intoxicated patients were excluded to select isolated injuries to the spine. 19 patients with isolated injury of the back were included. Serum samples for S-100B analysis and CT spine were obtained within 1 hours of injury. Results: CT scans showed vertebral fractures in 12 of the 19 patients (63%). All patients with fractures had elevated S-100B levels. Amongst the remaining 7 patients without a fracture, only one patient with a severe spinal contusion had an S-100B concentration above the reference limit. The mean S-100B value of the group with fractures was more than 4 times higher than in the group without fractures ( 0.385 vs 0.087 mug/L, p = 0.0097). Conclusion: Our data, although limited due to a very small sample size, suggest that S-100B serum levels might be useful for the diagnosis of acute vertebral body and spinal cord injury with a high negative predictive power. According to the literature, the highest levels of serum S-100B are found when large bones are fractured. If a large prospective study confirms our findings, determining the S-100B level may contribute to more selective use of CT and MRI in spinal trauma. http://www.sjtrem.com/content/16/1/13 Lorin M Benneker, Christoph Leitner, Luca Martinolli, Robert Kretschmer, Heinz Zimmermann and Aristomenis K Exadaktylos Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:13 2008-11-07 doi:10.1186/1757-7241-16-13 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 13 2008-11-07 We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported. Aetiology and current approach to spontaneous haemothorax are discussed briefly. http://www.sjtrem.com/content/16/1/12 Benjamin O Patterson, Sarah Itam and Fey Probst Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:12 2008-10-31 doi:10.1186/1757-7241-16-12 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 12 2008-10-31 ObjectivesIn the early minutes of cardiac arrest, timing of defibrillation and cardiopulmonary resuscitation during the basic life support phase (BLS CPR) is debated. Aims of this study were to provide in-hospital incidence and outcome data, and to investigate the relation between outcome and time from collapse to defibrillation, time to BLS CPR, and CPR quality. Methods: Resuscitation attempts during a 3-year period at St. Olav's University Hospital (960 beds) were prospectively registered. The times between collapse and initiation of BLS CPR, and defibrillation were determined. CPR quality was assessed by the resuscitation team. The relation between these variables and outcome (short term survival and discharge) was explored using non-parametric correlation and logistic regression. Results: CPR was started in a total of 223 arrests, an incidence of 77 episodes per 1000 beds per year. Return of spontaneous circulation occurred in 40%, and 29 patients (13%) survived to discharge. Median time from collapse to BLS CPR was 1 minute; CPR was judged to be of good quality in half of the episodes. CPR during the first 3 minutes in ventricular fibrillation (VF/VT) was negatively associated with survival, but later proved beneficial. For patients with non-shockable rhythms, we found no association between outcome and time to BLS or CPR quality. Conclusion: Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality. http://www.sjtrem.com/content/16/1/11 Eirik Skogvoll and Trond Nordseth Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:11 2008-09-22 doi:10.1186/1757-7241-16-11 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 11 2008-09-22 There is no abstract http://www.sjtrem.com/content/16/1/10 Hans Friberg Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:10 2008-09-15 doi:10.1186/1757-7241-16-10 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 10 2008-09-15 Background: Numerous parameters and tests have been proposed for outcome prediction in comatose out-of-hospital cardiac arrest survivors. We conducted a survey of clinical practice of prognostication after therapeutic hypothermia (TH) became common practice in Norway. Methods: By telephone, we interviewed the consultants who were in charge of the 25 ICUs admitting cardiac patients using 6 structured questions regarding timing, tests used and medical specialties involved in prognostication, as well as the clinical importance of the different parameters used and the application of TH in these patients. Results: Prognostication was conducted within 24–48 hours in the majority (72%) of the participating ICUs.The most commonly applied parameters and tests were a clinical neurological examination (100%), prehospital data (76%), CCT (56%) and EEG (52%). The parameters and tests considered to be of greatest importance for accurate prognostication were prehospital data (56%), neurological examination (52%), and EEG (20%).In 76% of the ICUs, a multidisciplinary approach to prognostication was applied, but only one ICU used a standardised protocol. Therapeutic hypothermia was in routine use in 80% of the surveyed ICUs. Conclusion: Despite the routine use of TH, outcome prediction was performed early and was mainly based on prehospital information, neurological examination and CCT and EEG evaluation. Somatosensory evoked potentials appear to be underused and underrated, while the importance of prehospital data, CCT and EEG to appear to be overrated as methods for making accurate predictions.More evidence-based protocols for prognostication in cardiac arrest survivors, as well as additional studies on the effect of TH on known prognostic parameters are needed. http://www.sjtrem.com/content/16/1/9 Michael Busch and Eldar Søreide Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:9 2008-09-15 doi:10.1186/1757-7241-16-9 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 9 2008-09-15 No abstract available. http://www.sjtrem.com/content/16/1/8 Karim Brohi Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:8 2008-08-28 doi:10.1186/1757-7241-16-8 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 8 2008-08-28 Background: In 1999, an Utstein Template for Uniform Reporting of Data following Major Trauma was published. Few papers have since been published based on that template, reflecting a lack of international consensus on its feasibility and use. The aim of the present revision was to further develop the Utstein Template, particularly with a major reduction in the number of core data variables and the addition of more precise definitions of data variables. In addition, we wanted to define a set of inclusion and exclusion criteria that will facilitate uniform comparison of trauma cases. Methods: Over a ten-month period, selected experts from major European trauma registries and organisations carried out an Utstein consensus process based on a modified nominal group technique. Results: The expert panel concluded that a New Injury Severity Score > 15 should be used as a single inclusion criterion, and five exclusion criteria were also selected. Thirty-five precisely defined core data variables were agreed upon, with further division into core data for Predictive models, System Characteristic Descriptors and for Process Mapping. Conclusion: Through a structured consensus process, the Utstein Template for Uniform Reporting of Data following Major Trauma has been revised. This revision will enhance national and international comparisons of trauma systems, and will form the basis for improved prediction models in trauma care. http://www.sjtrem.com/content/16/1/7 Kjetil G Ringdal, Timothy J Coats, Rolf Lefering, Stefano Di Bartolomeo, Petter Andreas Steen, Olav Røise, Lauri Handolin, Hans Morten Lossius and Utstein TCD expert panel Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:7 2008-08-28 doi:10.1186/1757-7241-16-7 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 7 2008-08-28 No abstract available http://www.sjtrem.com/content/16/1/6 Maaret Castrén Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:6 2008-08-19 doi:10.1186/1757-7241-16-6 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1757-7241 16 6 2008-08-19