The prevalence of impairments and disabilities in activities of daily living (ADL), nonwork activities, and work were registered in a consecutive series (n = 69) of subjects with severe injuries. At follow-up 3 years after trauma, residual impairments prevailed in 80%. Only a few (6%) were ADL-dependent. Seventy-six percent had lost at least one nonwork activity, while vocational disability caused by the trauma occurred in 19%. Cognitive impairment was significantly associated with vocational disability, while physical impairment and pain were significantly associated with nonwork disability. Other parameters that influenced vocational disability negatively were age and blue-collar employment status. Although overall changes in social network quantity and quality were small, significantly more subjects with cognitive impairment or vocational disability experienced a decline in the quality and quantity of their social network after trauma. Furthermore, 25% of the subjects reported an increase in feelings of loneliness after trauma. We recommend the design of individualized, multidisciplinary rehabilitation plans before discharge from departments of surgery.

A formal protocol adding mandatory AE to NOM for severe splenic injuries increased the percentage of patients in whom NOM was attempted, the NOM success rate, and the splenic salvage rate.

BackgroundPenetrating cardiac injuries in Europe have been poorly studied. We present a 10-year outcome for patients with penetrating heart injuries at Oslo University Hospital.MethodsData from 01.01.2001 until 31.12.2010 was collected from the Oslo University Hospital Trauma Registry and from the patients’ records.ResultsThirty-one patients were admitted with a penetrating cardiac injury. Fourteen patients survived (45 %). Four out of 8 patients (50 %) with gunshot wounds survived compared to 10 out of 23 (44 %) with stab wounds. Median (quartiles) for the following values were: Injury Severity Score 25 (21–35), Revised Trauma Score 0 (0–6,9), Probability of Survival 0,015 (0,004–0,956), Glasgow Coma Scale 3 (3–13). Thirteen patients had signs of life on admission and survived. Eighteen patients were admitted without signs of life and received emergency department thoracotomy. Eight of these had no signs of life at the scene of injury and did not survive. Out of the remaining 10 patients, one survived.ConclusionsThe outcome of patients with penetrating cardiac injury reaching the emergency department with signs of life was excellent. Hemodynamic instability indicates immediate surgery. Stable patients with penetrating thoracic trauma and possible cardiac injury detected by imaging should be considered for conservative treatment.

Therapeutic/care management study, level V.

: 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.

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16C. Gaarder et al. the prehospital careprovider with amoreorless obvious mechanismo fi njury,c omplaintsa nd symptoms, and with many uncontrolled factors making both diagnosis and triage achallenge.Vo lume loading results in adecrease in haemoglobin and clotting factors. Furthermore, the relative expansion with 500 ml of isotonic crystalloid is greater in as hocked person than in ah ealthy individual. The optimal volume of intravenous fluid to administer is abalance between avoiding hypovolaemia and not increasing systolic blood pressure(SBP) causing disruption of clots and further bleeding. To what extent this is moret han at heoretical worry in patients with blunt trauma, is not well documented. Several animal models of penetrating injury,h owever,h ave documented the relationship between increasing blood pressure, increased bleeding and fatal outcome.AS BP <90m mH gi su sed extensively to assess volume status in trauma patients, both for triage, treatment and study protocols. How well aSBP <90 mm Hg defines the presence of uncontrolled bleeding, the need for intravenous fluid resuscitation and later surgical interventions is still not clear.T herei s also some evidence to support the use of only manual SBP for pre-hospital, or hospital, triage decisions (1).In EMS (Emergency Medical Services) systems wherep re-hospital fluid therapy is used, the incidence of hypotension at hospital admission is lower than 10% and the need for immediate haemostatic surgery is low (5). Recent publications have reinforced the impression that fluid resuscitation and blood transfusion in the Emergency Department still aree ssential elements of early management in most critically injured patients. Hence, providing the same therapy earlier,i fn ot exaggerated, seems logical. A major concern with prehospital fluid therapy is that infusing cold fluids will cause hypothermia in the patients, afactor known to reduce clotting activity.Patients with severeT BI (traumatic brain injury) do not tolerate even short periods of hypotension. Hence, theu se of volume therapy to counteract hypovolaemia and hypotension is considered standard treatment by most authors. The discussion has been focused moreonwhat systolic blood pressuretoaim for and what fluid to use. RECOMMENDATIONS

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