Comparison of bystander trauma care for moderate versus severe injury.

At the scene of an accident, the most severely injured patients need trauma care urgently. Bystanders are often present before the emergency medical service arrives and may be able to limit trauma-related damage by providing trauma care at the scene. The aim of this prospective study conducted in Mainz, Germany, and Vienna, Austria, was to compare the frequency and quality of bystander trauma care in moderately versus severely injured patients. Five specific measures (making the scene readily visible for oncoming traffic, extrication and positioning of the trauma patient, control of haemorrhage, and hypothermia protection) were assessed in a questionnaire and evaluated statistically. Bystanders were present at the scene in 58.7% of all accidents. Making the scene readily visible for oncoming traffic, patient extrication and patient positioning were initiated significantly more often than haemorrhage control and hypothermia protection. Extrication, patient positioning and hypothermia protection were initiated significantly more often in moderately (NACA I-II) compared to severely (NACA III-VII) injured patients. In severely injured patients, bystanders attempted measures less frequently and the measures performed were more often incorrect compared to those in moderately injured patients. Our findings show that severely injured patients received less and less appropriate bystander trauma care than moderately injured patients. In an effort to correct this serious problem and to improve trauma care on-scene, we advocate offering lay persons more extensive training in bystander trauma care.

Circulating S100B is increased after bilateral femur fracture without brain injury in the rat.

BACKGROUND: S100B is an acknowledged marker of brain damage. However, trauma without brain damage also causes an increase in S100B. S100B concentrations are highest in multiple trauma patients with long bone fractures. Clinically, extensive long bone fractures are associated with haemorrhagic shock and haemorrhagic shock per se is associated with increased S100B. The aim of our experimental study was to verify the S100B increase in long bone fracture without haemorrhagic shock. METHODS: and results. Bilateral femur fracture was carried out in 10 anaesthetized rats. Blood samples were drawn for immuno-luminometrical S100B measurement 5, 15, 30, 120, and 240 min after fracture. Mean arterial pressure (MAP), heart rate, and body temperature were monitored continuously. S100B increased after bilateral femur fracture and reached a peak 30-120 min after fracture (P<0.001). MAP remained at a level which is not associated with shock in rats. Heart rate and body temperature remained unchanged. Autopsy verified open bilateral femur fracture surrounded only by small zones of clotted blood. CONCLUSIONS: S100B is increased in bilateral femur fracture without haemorrhagic shock in rats. This finding suggests that bone marrow is a potential extracerebral source of S100B.