Annals of emergency medicine
-
Prehospital trauma triage should permit accurate identification and transport of patients with critical injuries to trauma centers without overloading these centers with patients having minor injuries. In most trauma systems a combination of physiologic criteria (Trauma Score [TS]), mechanisms of injury (MOI), and anatomic injury (AI) are used as prehospital trauma triage criteria. The purpose of our study was to assess the predictive value of specific MOI and AI in detecting critically injured trauma victims (Injury Severity Score [ISS] of more than 15) and determine the best combination of TS, MOI, and AI that produced the lowest percentage of undertriage and overtriage. ⋯ A total of 97 patients had an ISS of more than 15. Three hundred forty-one (23%) had one of the specific MOI studied; 102 (6.9%) had one of the specific AI studied. Four hundred twelve patients (28%) had at least one of the study MOI or AI.(ABSTRACT TRUNCATED AT 250 WORDS)
-
A five-year retrospective study was undertaken to analyze the natural history of sternal fractures and to scrutinize the current method of management. Sixty-six patients with documented sternal fractures were evaluated. The most common mechanism of injury was motor vehicle accidents (59%). ⋯ The majority of these patients were managed by admission, observation, IV therapy, and placement of monitored beds. Our findings of no life-threatening sequelae suggest that we might question the necessity of current management criteria. This proves to be of special interest in view of the economic restraints imposed on health care today.
-
We describe our experience with 60 consecutive intubations using flexible fiberoptic nasotracheal technique in the emergency setting. Fifty-seven of the procedures were carried out by two emergency physicians initially trained on intubation manikins. A learning curve is constructed demonstrating that time to intubation is decreased after nine or ten intubations. ⋯ Bleeding occurred in 22% of patients; the technique failed in 13%. Failure to intubate with fiberoptic technique was associated with specific problems such as bleeding, tumor, or agitation. Our results demonstrate both the limitations and special use of flexible fiberoptic technique.
-
Capillary refill has been advocated as an indicator of perfusion status (shock) in seriously ill patients. An upper limit of normal of two seconds has been recommended; there is no published evidence that supports this value. To investigate the validity of the two-second upper limit of normal and to examine the variation of capillary refill with age and temperature, we measured capillary refill in 100 healthy child, 104 adult, and 100 elderly volunteers. ⋯ Application of the two-second upper limit of normal to our populations would result in a false-positive rate of 4.0% for the pediatric and adult male volunteers, 13.7% for the adult female volunteers, and 29.0% for the elderly volunteers. The upper limit of normal for adult women should be changed to 2.9 seconds, and the upper limit of normal for the elderly should be changed to 4.5 seconds if 95% of all normal patients are to be contained within the normal range. The temperature dependence of capillary refill raises questions regarding its reliability in the prehospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)
-
In the prehospital management of trauma, a variety of devices are used for immobilization of the spinal column during extrication and transport. Two of these commonly used immobilizers, the Zee Extrication Device and the long spinal board, use crisscrossing straps over the thorax to affix the patient to the device. Our study was designed to determine if these two devices alter pulmonary function in the healthy, nonsmoking man. ⋯ These differences reflect a marked pulmonary restrictive effect. The ratio FEV1:FVC can be normal or even slightly elevated with restrictive airway disease due to proportional reductions of each parameter. Correspondingly, we found no significant difference between prestrapping and poststrapping FEV1:FVC values (P greater than .05).(ABSTRACT TRUNCATED AT 250 WORDS)