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Sophia recommends a supplement in the British Journal of Surgery (2012;99(Suppl 1)) devoted to trauma care. Advances in surgical approaches and the use of tourniquets, haemostatic dressings and novel intravenous fluids are discussed in an article heralding the beginning of the end for damage control surgery (2012;99(Suppl 1):10–11). Following on, a review of trauma induced coagulopathy speculates that future treatment may be based upon a combination of systemic antifibrinolytics, local haemostatics, and individualised point of care guided rational use of coagulation factor concentrates (Suppl 1:40–50). Indicators of the quality of trauma care are considered later in the supplement (Suppl 1:97–104). Traditional markers of quality have relied upon rates of death/survival in hospital, but it is now acknowledged that these are rather crude measures. Work is under way to develop measures of performance which include morbidity, functional long-term outcomes as well as mortality.
Propofol for painful procedures
A randomised prospective study compared propofol with ketamine/midazolam sedation in the ED for painful orthopaedic manipulations. Specific comparisons included recovery time, total sedation time, adverse …