American journal of surgery
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Comparative Study
Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces.
Although posttraumatic pneumothoraces (PTXs) are common and potentially life threatening, the supine chest radiograph (CXR) is an insensitive test for their detection. Computed tomography (CT) often identifies occult pneumothoraces (OPTXs). Previous descriptions of OPTX topography have been poor. Our purpose was to define their distribution and aid in the targeting of thoracic ultrasound. ⋯ CXR missed over half of all PTXs. OPTXs had a greater anterior versus lateral (nearly 4-fold) and both basal and apical versus lateral (2-fold) distribution. OPTXs are often located at easily accessible sonographic windows.
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Forward Surgical Teams (FSTs) are 20-person units designed to perform front-line, life-saving combat surgery. This study compares the employment, injuries encountered, and workload of an airborne FST in two widely varying campaigns. ⋯ Although the number and types of combat casualties were similar between the campaigns, employment of the FST changed dramatically in OIF because of increased medical reconstruction missions.
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Cardiac performance may be assessed noninvasively at the patient's bedside by using thoracic bioimpedance. However, it is unclear if this technique can be used reliably in critically injured obese patients because of increased body habitus and chest wall mass. ⋯ Thoracic bioimpedance technology may be used reliably as a noninvasive alternative to pulmonary artery catheterization for assessment of cardiac performance in critically injured obese patients.