Annals of emergency medicine
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Analysis of 164 percutaneous chest tube thoracostomies performed as a standardized technical procedure in the management of 129 blunt trauma victims demonstrated an overall complication rate of 9.1% (15 of 164). Three complications (1.8%) were related to problems of insertion, and four (2.4%) represented the problem of pneumothorax after chest tube removal. ⋯ Percutaneous chest tube thoracostomy remains an important facet in the management of certain types of blunt thoracic trauma. Associated risks can best be minimized with adherence to a standardized technique and management protocol.
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Comparative Study
Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: a multicenter study.
A group of 1,273 blunt trauma patients who were treated and transported from the site of injury by seven different hospital-based rotorcraft aeromedical emergency care services were studied using a methodology based on injury severity designed to predict the mortality of such patients. The methodology predicted that 241 patients should have died; 191 patients did die. ⋯ The reduction was statistically significant (P less than .05) in five of the seven aeromedical services, or 86% of the total patient cohort. Hospital-based rotorcraft aeromedical emergency care services may reduce the expected mortality of blunt trauma patients treated at the site of injury.
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The usefulness of peripheral venous sampling in determining acid-base status in acutely ill patients was studied. A total of 171 nonarrest patients and 12 patients in cardiac arrest had paired samples of arterial and venous blood compared for correlation of blood gas results. Linear equations relating arterial and venous values of pH, PCO2, and bicarbonate were developed in both groups of patients; however, the accuracy of predicting arterial values from venous values was limited. ⋯ Extremely abnormal venous levels reliably reflected comparable arterial abnormalities. The results suggest that immediate intravenous bicarbonate therapy should be considered for patients with pH less than or equal to 7.05 and PCO2 less than or equal to 40 torr despite the possibility of inadvertent venous sampling. A larger series is needed to verify these results in the setting of cardiac arrest.
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Hypothermia is a common complication in fluid resuscitation of the hypovolemic patient. Warm intravenous (IV) fluids have been shown to be a valuable adjunct in volume replacement to prevent this complication. A rapid method of warming IV fluids is the microwave oven. ⋯ Heating on a warm cycle to room temperature, 21 C, caused an average 26% increase in plasma hemoglobin. Therefore, we do not advocate microwave warming of PRBC because of the possible danger of local overheating, which causes hemolysis. We warm PRBC secondarily by diluting with microwave-warmed, calcium-free crystalloid.