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A shift of approach from 'clinics trying to fit physiology' to the one of 'physiology to clinics', with interpretation of the clinical phenomena from their physiological bases to the tip of the clinical iceberg, and a management exclusively based on modulation of physiology, is finally surging as the safest and most efficacious philosophy in hemorrhagic(More)
BACKGROUND Penetrating thoracic injury is commonly found in South Africa. A review of our recent experience was undertaken to assess the effectiveness of our protocols for this type of injury. METHODS A retrospective study of 61 consecutive patients with penetrating, non-mediastinal trauma to the chest was conducted over 32 months at a single trauma unit.(More)
Penetrating cardiac injury is a dramatic and lethal form of trauma. The majority of patients will die before reaching medical care, but for those who arrive at hospital alive, the diagnostic acumen and rapid surgical intervention of physicians and surgeons can lead to successful outcomes. A structured diagnostic and management approach is used in our trauma(More)
SHOCK SYNDROMES ARE OF THREE TYPES: cardiogenic, hemorrhagic and inflammatory. Hemorrhagic shock has its initial deranged macro-hemodynamic variables in the blood volume and venous return. In cardiogenic shock there is a primary pump failure that has cardiac output/mean arterial pressure as initial deranged variables. In Inflammatory Shock it is the(More)
Shock as reaction to life-threatening condition needs to be reclassified in a timely and more scientific synopsis. It is not possible or beneficial any longer to avoid a holistic approach in critical illness. Semantics of critical illness has often been unfriendly in the literature and a simplification with the elimination of conceptual pleonasms and(More)
An algorithm on the indications and timing for a surgical airway in emergency as such cannot be drawn due to the multiplicity of variables and the inapplicability in the context of life-threatening critical emergency, where human brain elaborates decisions better in cluster rather than in binary fashion. In particular, in emergency or urgent scenarios,(More)
Penetrating injuries such as gunshot wounds have traditionally been rare in Europe, with the result that European surgeons have only limited experience in their management. Socio-economic changes in the last decade have led to an increase in the frequency of injuries of this type, partly due to the expansion of organized crime and partly because of(More)
The clinical aspects of shock syndromes are described from their inception as compensated physiology to a stage of decompensation. The clinical significance of hypotension, fluid-responsive and non fluid-responsive hypotension, is discussed. Untimely or inadequate treatment leads to persistent subclinical shock despite adjustments of the macrohemodynamic(More)
Penetrierende Verletzungen wie Schusswunden sind in Europa selten, weshalb die Erfahrungen europäischer Chirurgen auf diesem Gebiet begrenzt sind. Sozioökonomische Veränderungen haben im letzten Jahrzehnt zu einer Zunahme penetrierender Verletzungen geführt, zum einen durch die Ausweitung des organisierten Verbrechens, zum anderen durch die Beteiligung des(More)