J Trauma
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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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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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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.