American journal of surgery
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Our objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients. ⋯ Our pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.
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Patients sustaining fatal gunshot wounds to the head are often young, without associated comorbidities, and are potentially ideal transplantation candidates. ⋯ Despite frequent intensive care unit admissions, organ donation is infrequent following fatal gunshot wounds to the head, primarily because of lack of consent. Improved communication with next of kin could improve organ recovery and reduce futile care in this group.
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By the principles of Tactical Combat Casualty Care, battlefield casualties are preferentially triaged on the basis of pulse character and mental status. A weak or absent palpable pulse correlates with a systolic blood pressure (SBP) of ≤ 100 mm Hg. Furthermore, the motor component of the Glasgow Coma Scale (GCS-M) has been shown to correlate with outcomes. In a previous study, the authors developed a simple triage tool, the field triage score (FTS), on the basis of pulse character and GCS-M status, which provided a quick and effective means of predicting injury survival in the civilian trauma environment. The purpose of this analysis was to validate the predictive utility of the FTS in the battlefield trauma environment. ⋯ This study has validated the utility of the FTS as a simple and practical triage instrument for use in the battlefield environment. Using the FTS, medics and medical providers will have a quick and effective measure to predict high-acuity combat casualties to triage evacuation and medical resources in austere military environments. This technique may have potential implications for domestic or foreign disaster or mass casualty situations in which supplies, medical resources, and facilities are limited.
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The management of surgical sepsis is challenging because of the complexity of interventions. The authors therefore created a computerized clinical decision support program to facilitate this process, with the goal of improving abdominal sepsis mortality. ⋯ The use of computerized clinical decision support results in significantly improved survival in patients with intra-abdominal surgical sepsis.
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We performed an evaluation of antimicrobial guidelines for patients with surgical sepsis. ⋯ Our current antibiotic guidelines provide appropriate and accurate antimicrobial coverage. Noncompliance with the antibiotic protocol resulted in fewer ICU-free days and increased hospital mortality in surgical sepsis patients.