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Biomedical subjects

K D Boffard

Publications and source records attributed to K D Boffard.

At least 19 recordsLinked to original sources
PubMed2004

Damage control in the abdomen and beyond.

BACKGROUND: Damage control is not a modern concept, but the application of this approach represents a new paradigm in surgery, borne out of a need to care for patients sustaining multiple high-energy injuries. METHODS: A Medline search was performed to locate English language articles relating to damage control procedures in trauma patients. The retrieved articles were manually cross-referenced, and additional academic and historical articles were identified. RESULTS AND CONCLUSION: Damage control surgery, sometimes known as 'damage limitation surgery' or 'abbreviated laparotomy', is best defined as creating a stable anatomical environment to prevent the patient from progressing to an unsalvageable metabolic state. Patients are more likely to die from metabolic failure than from failure to complete organ repairs. It is with this awareness that damage control surgery is performed, enabling the patient to maintain a sustainable physiological envelope.

Abdominal Injuries↗
PubMed2004

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims.

OBJECTIVES: To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department. METHODS: A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory. RESULTS: Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0-88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a "high" degree of professional burnout in the three sub-scales of the Maslach burnout tnventory-that is emotional exhaustion, depersonalisation, and personal accomplishment. CONCLUSIONS: Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

Accidents, Traffic↗
PubMed2001

[Penetrating trauma of the trunk].

Trauma has been described as a "disease of bleeding" [45]. Recognition of acute blood loss after injury, and restoration of homeostasis is the cornerstone of the initial care of the badly injured patient. Hypovolaemia remains the most common cause of death among those killed in action during military conflicts [46] and, in the civilian arena, increasing numbers of patients are being encountered with penetrating injuries, even in societies where blunt injury have previously been the norm. Increased use of higher calibre weapons or with altered ammunition means some patients will present with exsanguinations and critical physiological instability. Successful outcomes after the treatment of patients with penetrating trauma depend on the integration of many agencies, from prehospital care, initial reception, assessment and resuscitation through the operating room, intensive care and post-injury rehabilitation. Recognition of the importance of time and adherence to sound trauma management principles with conservative management when appropriate should see further improvements in our treatment of this important group of patients. Reducing the incidence of these injuries is the responsibility of us all and must be the focus of all governmental initiatives.

Abdominal Injuries↗
PubMed2001

Evolving concepts in the management of colonic injury.

PURPOSE: The management of colonic injury has changed in recent years. This study sought to evaluate current surgical management of injuries to the colon in a busy urban trauma centre, in the light of our increasing confidence in primary repair and evolving understanding of the concepts and practice of damage control surgery. METHODS: A retrospective analysis was made of consecutive patients presenting with colonic injury from January 1 to December 31 1998. Patients without full-thickness lesions of the colon were excluded, as were patients who died within 24 h of admission. Demographic data, wounding patterns and clinical course were studied. RESULTS: One hundred twenty-seven patients were analyzed. Management without colostomy was achieved in 84% of cases. Patients who underwent diversion of the faecal stream had increased morbidity and hospital stay compared to equivalent patients who were repaired primarily. The important subgroup of patients who underwent damage control or abbreviated laparotomy is discussed. CONCLUSION: This study further strengthens the validity of direct repair or resection and primary anastomosis for colonic injury. Strategies to deal with the subgroup of patients at very high risk of postoperative complications are suggested.

Accidents, Traffic↗
PubMed2000

Damage control surgery--concepts and practice.

The results of prolonged and extensive procedures in the critically injured are poor, even in experienced hands. The operating theatre is a hostile and physiologically unfavourable environment for the severely injured patient. Laparotomy for major trauma involves dissipation of heat and massive blood loss requiring replacement. The result is a vicious cycle of hypothermia, acidosis and coagulopathy leading to death from an irreversible physiological insult (62). The damage control concept places surgery as an integral part of the resuscitative process, rather than an end in itself, and recognises that outcomes after major trauma are determined by the physiological limits of the patient, rather than by efforts of anatomical restoration by the surgeon. All those involved in the care of wounded patients should be familiar with this concept and its surgical and logistical implications.

Acidosis↗
PubMed1999

Education of the trauma team: video evaluation of the compliance with universal barrier precautions in resuscitation.

OBJECTIVE: To assess the effectiveness of an educational symposium designed to improve compliance with universal barrier precautions by the use of video analysis of resuscitations. DESIGN: Prospective single blind analysis of data. SETTING: Hospital Trauma Unit, Johannesburg, South Africa. SUBJECTS: 100 severely injured patients who presented to the emergency room, divided into two study periods. INTERVENTIONS: An educational symposium held between the study periods, which focused on universal barrier precautions and the risk of occupational transmission of HIV. MAIN OUTCOME MEASURES: Compliance with items of universal precautions; mechanism; Injury Severity Score and Revised Trauma Score. RESULTS: There was a significant improvement in compliance from 48% to 74% after the symposium (p = 0.007), with specific improvement in the wearing of masks and visors. Initially there was poor compliance with universal precautions in severely injured patients, which significantly improved to 83% compliance (p = 0.0004). CONCLUSION: Video analysis of resuscitations is an effective audit and educational tool that allows analysis of compliance with protocol. The education symposium was effective in altering attitudes and behaviour towards universal barrier precautions.

Education, Medical, Continuing↗
PubMed1995

Extraperitoneal rectal gunshot injuries.

Extraperitoneal rectal gunshot injuries are rare, but may be encountered in civilian practice. We report on a series of 26 such cases. The aim of the study is to attempt to evolve a treatment policy of this injury. The principles of management include the repair of rectal wound in selected cases and the formation of a diverting colostomy. Distal rectal washout and presacral drainage, although advocated by some authors, do not seem to be indispensable adjuncts to the management of these injuries.

Adolescent↗
PubMed1993

Urban bomb blast injuries: patterns of injury and treatment.

A review of many series reporting injuries following blasts, data allows certain conclusions to be made: 1. Most patients sustain minor injuries, which may be treated on an outpatient basis. 2. Injuries predominantly affect the head and neck and the periphery, which suggests that clothing plays a major role in protection from secondary injuries. 3. Injuries to the chest and abdomen are relatively uncommon but have a high mortality, also associated with head injury. 4. Primary blast injuries are uncommonly seen in a hospital setting, because they usually result in immediate death.

Blast Injuries↗
PubMed1992

The Johannesburg Hospital mobile anaesthesia service.

At a teaching hospital such as the Johannesburg Hospital with an air ambulance service, the need may arise for the administration of an anaesthetic outside the hospital. The occurrence of just such an event prompted the authors to review the literature regarding anaesthesia in adverse circumstances and to assemble, in a portable container, the equipment and drugs considered necessary to cope with the situation. In addition, the responsible anaesthetic personnel are receiving training in the use of the equipment and techniques required.

Aircraft↗
PubMed1990

Gut barrier function and the surgeon.

There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called 'bacterial translocation') and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.

Animals↗
PubMed1989

Emergency room arteriography: a useful technique in the assessment of peripheral vascular injuries.

Emergency room arteriography is a useful aid in the assessment of limbs for possible vascular injury. It can be performed quickly by junior staff in the emergency room, using simple equipment, thereby avoiding the delays commonly associated with formal radiology suite arteriography. It can also be performed in units which lack formal arteriographic facilities, and resuscitation procedures need not be interrupted while this procedure is being performed. The resulting pictures are adequate for immediate diagnosis of vascular lesions and are of great value to the trauma surgeon. This pilot study of 50 cases confirms that emergency room arteriography is a safe and effective means of diagnosis in the resuscitation area and that the films are as useful as formal angiography for immediate diagnosis of vascular lesions of a traumatic nature.

Angiography↗