The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Prospective evaluation of selective nonoperative management of torso gunshot wounds: when is it safe to discharge?
Selective nonoperative management (NOM) has been increasingly used for torso gunshot wounds (GSWs). The optimal observation time required to exclude a hollow viscus injury is not clear. The purpose of this study was to determine the safe period of observation before discharge. ⋯ In the initial evaluation of patients sustaining a GSW to the torso, clinical examination is essential for identifying those who will require emergency operation. For those undergoing a trial of NOM, all failures occurred within 24 hours of hospital admission, setting a minimum required observation period before discharge.
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J Trauma Acute Care Surg · Apr 2012
Nonsurgical management of delayed splenic rupture after blunt trauma.
Delayed splenic rupture (DSR) is a rare manifestation of blunt splenic trauma, and splenectomy remains the primary treatment for patients with DSR. The purpose of this study was to review our experience with nonsurgical management of DSR with the use of splenic artery embolization (SAE) as an adjunct treatment. ⋯ Nonsurgical management can safely be used in selected patients with DSR, especially for those with a good response to resuscitation. SAE is as effective for DSR as it is for acute splenic injury. Physicians should consider SAE as an option for the treatment of DSR.
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J Trauma Acute Care Surg · Apr 2012
Efficacy of beta-blockade after isolated blunt head injury: does race matter?
Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity. ⋯ Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.
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Neck injury represents 11% of battle injuries in UK forces in comparison with 2% to 5% in US forces. The aim of this study was to determine the causes of death and long-term morbidity from combat neck injury in an attempt to recommend new methods of protecting the neck. ⋯ Nape protectors, that cover zone III of the neck posteriorly, would only have potentially prevented 3% of injuries and therefore this study does not support their use. Current UK OSPREY neck collars potentially protect against the majority of explosive fragments to zones I and II and had these collars been worn potentially 16 deaths may have been prevented. Reasons for their lack of uptake by UK servicemen is therefore being evaluated. Surface wound mapping of penetrating explosive fragments in our series has been used to validate the area of coverage required for future designs of neck protection.
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J Trauma Acute Care Surg · Apr 2012
Fresh frozen plasma/red blood cell resuscitation regimen that restores procoagulants without causing adult respiratory distress syndrome.
Controversy exists about the ideal fresh frozen plasma/red blood cell (FFP/RBC) ratio for resuscitation of patients requiring massive transfusion (MT). This study correlates the FFP/RBC with clotting time (CT), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT); with procoagulants (fibrinogen [FI], factor 5 [FV], and factor 8 [FVIII]); and with adult respiratory distress syndrome (pO2/FIO2). ⋯ These data show that an FFP/RBC ratio above 0.31:1 in injured patients requiring MT restores CTs and procoagulant to clinically effective levels while not causing adult respiratory distress syndrome. Future studies on defining the ideal FFP/RBC ratio for MT should monitor CTs, procoagulants, and organ function.