Annals of emergency medicine
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One hundred eighteen deaths from motor vehicle accidents were reviewed retrospectively to evaluate the effect of implementation of a regional trauma system. Fifty-eight deaths occurring prior to implementation and 60 occurring after were reviewed by teams of four physicians. Following implementation the proportion of potentially salvageable deaths dropped from 34% (20/58) to 15% (9/60) (P less than .02). ⋯ The median age of patients dying of trauma rose from 22 to 27 years (P less than .04); the median Injury Severity Score rose from 42.5 to 52.0 (P less than .03). The 1981 death rate for vehicular trauma dropped to 13.93 per 100,000 population compared to a projected rate of 15.72 (P less than .03); the 1982 rate dropped to 12.37 compared to a projected rate of 15.80 (P less than .02). Implementation of a regional trauma system has resulted in significant improvements in trauma care and a reduction in the death rate from vehicular trauma.
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The aortic compressor is a device that allows rapid, simple, immediately reversible occlusion of the thoracic aorta, without the aortic dissection required to use an aortic cross-clamp. We evaluated the aortic compressor in a controlled study using a canine hemorrhagic shock model. Twelve mongrel dogs were exsanguinated to a mean arterial pressure (MAP) of 47 mm Hg and maintained at that level for 20 minutes. ⋯ At the same time the compressor prevented blood flow to the abdominal aorta. If the canine model can be extrapolated to human application, then the aortic compressor would be expected to enhance perfusion of the heart and brain during hemorrhagic shock, prevent further arterial blood loss from intra-abdominal injury or ruptured abdominal aortic aneurysm, and preserve already diminished cardiac output. Because the aorta does not need to be dissected out to use the compressor, there is no risk of injury to nearby vascular structures.