The American surgeon
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The American surgeon · Nov 2008
Adding insult to injury: neck exploration for penetrating pediatric neck trauma.
Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration. ⋯ The hospital length of stay was longer in the patients who underwent exploration. Mandatory exploration of the neck in children should not be performed unless clinically indicated. Preoperative imaging should be used liberally to limit nontherapeutic explorations, improve diagnostic accuracy, and reduce morbidity.
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The American surgeon · Nov 2008
Value of ultrasound guidance in placement of hemodialysis access catheters in patients with end-stage renal disease.
The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. ⋯ Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded centralveins. This protocol is effective and improves patient safety.
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The American surgeon · Nov 2008
On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma.
Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV). ⋯ Excluding dead on-scene patients, mean EMS time on-scene when mortalities occurred in rural and urban settings was 18.9 minutes and 10.8 minutes, respectively (P < 0.005). On-scene IV insertion occurred with significantly greater frequency in rural than urban settings. This incurs greater EMS time on-scene and prehospital time that may be associated with increased vehicular fatality rates in rural settings.
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The American surgeon · Nov 2008
Intracranial pressure monitoring in severe isolated pediatric blunt head trauma.
Very little research regarding standard treatments for pediatric traumatic brain injury (PTBI) exists. The objective of this study was to examine the use of intracranial pressure (ICP) monitoring devices in PTBI and to determine if its use was associated with any outcome benefit. Data were collected from the Trauma Registry over an 11-year period (1996-2006) on all blunt trauma pediatric patients (age < 14 years) with an initial Glasgow Coma Scale score < or =8. ⋯ After multivariable analysis to adjust for the differences between the two study groups, the use of ICP monitor provided no survival benefit (adjusted odds ratio: 1.1; 95% confidence interval [CI]: 0.3-4.1; adjusted P value = 0.85). The use of ICP monitor was, however, independently associated with a higher risk of developing extracranial complications (adjusted odds ratio: 4.3; 95% CI: 1.2-16.4; adjusted P value = 0.025). In conclusion, the use of ICP monitors in pediatric patients with severe isolated head injury provided no survival benefit and was associated with an increased risk of complications.