This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/
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Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.
Summary
This article reports two cases of severe blunt pelvic trauma associated with road traffic accidents, where the patients developed significant bleeding and haemodynamic instability, poorly responsive to conventional management. Both patients required massive transfusion of blood products with a resultant dilutional coagulopathy. In each case, a single dose of recombinant activated factor VII (rFVIIa) was used to achieve haemostatic control, with a subsequent decrease in blood product requirements and improvement in haemoglobin concentration and clotting profile.
We report a 63-year-old patient with lateral medullary syndrome secondary to a medullary haemorrhage, causing unilateral vocal cord palsy which precipitated respiratory failure sufficient to warrant intubation and ventilation. The patient recovered completely following neurological rehabilitation and was discharged home a month later. Centrally-mediated vocal cord palsy is a rare cause of stridor, but should be suspected in cases where no other local cause can be found.
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