The American surgeon
-
The American surgeon · Apr 1988
Impact of emergency room laboratory studies on the ultimate triage and disposition of the injured child.
One hundred sixty six surviving pediatric trauma patients were retrospectively studied to assess the contribution of initial laboratory evaluations to clinical decision making in the emergency department (ED). All laboratory tests ordered, the results of those tests and the number of test results available before patient disposition from the ED were reviewed. A total of 626 laboratory studies were ordered in 166 patients. ⋯ Based on this data, the current protocol has been revised to include hemoglobin/hematocrit determinations, type and screen, and urinalysis. Additional blood is obtained and appropriately labeled so that further studies can be performed if the patient's management should require baseline laboratory evaluations. This approach is more efficient, cost-effective, and no less sensitive in the initial evaluation and management of the injured child.
-
Accidental injury continues as the leading cause of mortality in children and adolescents. With the recent push for improvement in emergency medical services and specialized trauma centers for this age group, more moribund patients can be expected to reach these centers. Multiple reports document the efficacy of resuscitative thoracotomy in the moribund adult trauma victim, but published reports of this technique in children and adolescents are lacking. ⋯ This review confirms the efficacy of resuscitative thoracotomy in the patient with penetrating trauma. Salvage in the blunt trauma victim is possible, but less than in penetrating injuries (12.5% versus 36%). Further studies in this age group will be necessary to establish appropriate guidelines for the use of RT in children and adolescents.
-
The American surgeon · Apr 1988
Rapid sequence induction with oral endotracheal intubation in the multiply injured patient.
The charts of 1798 consecutive admissions at this level one trauma center to evaluate the practice of emergency airway control were reviewed. A total of 335 patients required endotracheal intubation, 320 oral endotracheal, 12 nasotracheal, and three surgical. A technique of rapid sequence induction (RSI) with oral endotracheal intubation was the method of airway control in 260 spontaneously breathing patients. ⋯ In all instances airway control was prompt and accurate. There were no hemodynamic nor neurologic complications secondary to RSI or oral endotracheal intubation. It is believed that RSI with oral endotracheal intubation is a reasonable alternative to nasotracheal intubation in the spontaneously breathing patient.
-
In recent years, trauma care delivery has come under close scrutiny from within and outside the medical profession. With the development and designation of trauma centers, two problems have become evident. First is a reliable, simple means of triaging patients to the appropriate facility. ⋯ From July 1, 1985 through June 30, 1986, 495 patients were admitted to the trauma service at the Medical College of Georgia. All patients were given a trauma score on arrival to the emergency department. The trauma score can be used as a quality assurance tool by any physician or hospital providing trauma services as will be demonstrated by analyzing our data.