J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Hypertonic saline fluid therapy following surgery: a prospective study.
Successful resuscitation of the injured may be achieved more rapidly and with less fluid using hypertonic crystalloid solutions than with isotonic solutions. This randomized, double-blind study compared 0.9% normal saline (NS) to 1.8% hypertonic saline (HS) in 20 postoperative coronary artery bypass patients suffering uniform injury. Study solutions were administered to maintain physiologic endpoints: heart rate, blood pressure, and pulmonary capillary wedge pressure. ⋯ No deaths occurred and no complication was attributed the hypertonicity of the solution. We conclude that 1.8% hypertonic saline is a safe alternative to isotonic crystalloid therapy in the fluid management of postoperative patients. Decreased third-space losses may occur with HS as suggested by the lower thoracic losses in the HS group; 1.8% NaCl may be the preferred solution in situations where excess free water administration is not desired, and where interstitial edema is detrimental to function and/or survival.
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Review Case Reports
Blunt chest trauma with transection of the azygos vein: case report.
A review of the world literature revealed only five reported cases of azygos vein disruption from blunt chest trauma. Four of these were isolated injuries. ⋯ Emergency thoracotomy and venous ligation resulted in successful resuscitation. Shearing forces as a result of deceleration were felt to be a possible etiology.
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Review Case Reports
Floating dislocated elbow: case report and review of the literature.
A 59-year-old shrimper sustained ipsilateral fractures of the midshafts of the humerus, ulna, and radius, as well as an ipsilateral posterior dislocation of the elbow. The mechanism of this unusual injury involved the winch system of a shrimpboat. Closed reduction of the dislocation along with open reduction and internal fixation of the fractures allowed early elbow motion. The resulting final range of motion and function were good.
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A prospective cohort study was undertaken to determine the effectiveness of air transport for major trauma patients when transferred to a trauma center from a rural Emergency Department. The null hypothesis evaluated was that there was no difference in outcome for patients transported by helicopter EMS (HEMS) when compared to patients transported by conventional ground EMS. The dependent variable of outcome was studied using the TRISS method in a group of 872 consecutive trauma patients admitted after long-distance transfer. ⋯ The benefit of HEMS transport was seen only in the patients with a probability of survival of less than 90%. We conclude that the major trauma patients transported by HEMS had a better outcome than those transported by ground EMS. The benefit seen with HEMS was directly related to injury severity and was demonstrated only in the patients with a Ps of less than 0.90.
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The authors report the case of a patient presenting with an acute extradural hematoma and diffuse axonal injury. Control CT scan performed 4 hours later showed the complete resolution of the extradural collection together with increased evidence of shearing injuries. The mechanism of the hematoma resolution may probably be related to the concomitant acute brain swelling.