J Trauma
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The Boston Emergency Medical Service system was studied to determine the effects of Advanced Life Support (ALS) prehospital trauma care compared to Basic Life Support (BLS) treatment. The severity of injury and clinical status of patients was defined and monitored using the Trauma Score (TS) described by Champion. ⋯ Furthermore, a positive change in prehospital TS was significantly related to an increased chance of long-term survival for any given severity of injury (p = 0.0002). From these data we conclude that the TS is useful for prehospital triage and that appropriate field ALS resuscitation results in more favorable outcomes following major trauma.
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Case Reports
Superior laryngeal nerve block: an aid to intubating the patient with fractured mandible.
Awake nasotracheal intubation in the patient with a fractured mandible may be facilitated by combining bilateral superior laryngeal nerve block with topical application of local anesthetic to the nose, mouth, and trachea. Successful use of this technique is described in two such patients.
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Posterior sternoclavicular joint dislocations are thought to be exceedingly uncommon. Two recent cases are discussed in terms of diagnosis, management, and potential risk to the patient. ⋯ Sternal oblique X-rays and tomograms are helpful in diagnosis. This entity may be promptly recognized and treated in the emergency department with gratifying results.
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Provided herein is a summary of findings by the authors and other investigators regarding the application of evoked potential studies to the assessment of neurologic function in severely head-injured patients in the acute and subacute stages postinjury. Multimodality Evoked Potentials (MEP's) are reportedly useful in three primary areas: 1) diagnosis; 2) prognosis; and 3) monitoring recovery. In diagnosis, the abnormalities in MEP's can be associated specifically with focal sensory/motor deficits such as hemiparesis and, generally, with the severity and extent of brain dysfunction. ⋯ Their accuracy is superior to many commonly used indices and MEP results add strength to clinical indicators of prognosis. Changes in MEP results obtained within a patient over time can be used to trace recovery and assess, for an individual, the functional consequences of secondary neurologic insult or medical complication. The authors conclude that MEP studies may serve a useful function as noninvasive indices of neurologic function in the management of severely head-injured patients.
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The effect of sepsis in modifying post-surgical fuel utilization in critically ill patients was determined from 374 observations (246 septic [S] and 128 nonseptic [N] in 12 intubated ICU patients studied serially. Patients received TPN (values/24 hrs: Septic, N2, 9.1 +/- 2.2 gm; glucose, 543 +/- 211 kcal/m2, Nonseptic, N2, 8.3 +/- 3.6 gm; glucose, 550 +/- 346 kcal/m2). In some periods, intravenous lipid (L) was given to raise total caloric intake to 826 +/- 223 kcal/ 24 hr/m2. ⋯ During hypercaloric lipid infusion in septic patients (SL) VO2 and VCO2 increased but VO2 was still greater, so RQ remained low (SL RQ = 0.89). As sepsis worsened VO2 remained high but VCO2 fell producing RQ less than 0.8, while plasma glucose levels were increased. These data suggest that septic patients are more dependent than nonseptics on lipid fuels for oxidative metabolism, and that IV lipids can be used to increase oxidative metabolism in sepsis at a time when glucose metabolism appears reduced.