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The care of the severely injured patient should be performed in structured fashion according to the A-B-C-D-E scheme, which involves the securing of the airway, breathing, and circulation, the recognition of neurologic deficits, and whole-body examination by the interdisciplinary team.

Epidemiologic study, level III. Therapeutic/care management study, level IV.

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BackgroundAn animal polytrauma model was developed, including trunk and extremity injuries combined with hemorrhagic shock and a prolonged post-traumatic phase. This could be useful for the assessment of different therapeutic approaches during intensive care therapy.MethodsA standardized polytrauma including lung contusion, liver laceration and lower leg fracture was applied in 25 pigs. They underwent controlled haemorrhage either with a blood volume loss of 45 % and a median arterial pressure (MAP) <30 mmHg/90 min (group L, n = 15) or a 50 % blood loss of and an MAP <25 mmHg/120 min (group H, n = 10). Five non-traumatized pigs served as a control (group C). Subsequently, intensive care treatment was given for an observational period of 48 h.ResultsBoth trauma groups showed signs of shock and organ injury (heart rate, MAP and lactate). The frequency of cardiopulmonary resuscitation (CPR) and lung injury was directly related to the severity of the haemorrhagic shock (CPR—group L: 4 of 15 pigs, group H: 4 of 10 pigs; Respiratory failure—group L: 3 of 13, group H: 3 of 9. There was no difference in mortality between trauma groups.ConclusionThe present data suggest that our model reflects the mortality and organ failure of polytrauma in humans during shock and the intensive care period. This suggests that the experimental protocol could be useful for the assessment of therapeutic approaches during the post-traumatic period.

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The sonograms of 115 infants with normal renal function ranging in age from 1 to 120 days used to determine renal parenchymal echogenicity by densitometry. The measured values were contrasted with the evaluations of 4 independent examiners who rated renal echogenicity as "less than", "equal to" or "greater than" that of the liver. The results revealed that naked eye evaluation does not permit a clear distinction between the categories of echogenicity and also that the assessments of the individual examiners differed considerably. Contrary to the previously held view the present findings indicate that the initially increased renal parenchymal echogenicity in neonates has developed into the normal hypoechoic condition after 1 month. One should take these findings into account when evaluating renal sonograms of infants, especially if no densitometric data are available.