J Trauma
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Triple-contrast CT scanning (3-CT) is a diagnostic modality that has been introduced recently for the work-up of patients with penetrating injuries to the back or flank. Triple-contrast CT consists of giving oral, intravenous (IV), and rectal contrast medium. Our hypothesis was that this test is an accurate predictor of the absence of a retroperitoneal injury requiring surgical repair. ⋯ Seventy-nine patients had non-high-risk scans. Seventy-seven were observed without complication, and two were explored for positive DPL, with no significant lesion found. The negative predictive value of a low- or moderate-risk 3-CT scan is 100% +/- 11%.
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Hypothermia is a major problem in patients who have sustained trauma. We reviewed the cases of 100 consecutive trauma patients transferred directly to the operating room (OR) from the Emergency Department (ED) in a Level I trauma center; 26 cases could not be evaluated. Forty-two patients (57%) became hypothermic at some time between injury and leaving the OR. ⋯ Hypothermia was associated with lower Trauma Scores, and those patients who were severely hypothermic received more intravenous fluids. However, the impact of fluid infusion was not independent from Trauma Score and did not fully explain the magnitude of the heat loss. These data suggest that hypothermia in trauma patients has a multifactoral etiology related to the magnitude of injury and that the major T loss occurs in the ED rather than in the OR.(ABSTRACT TRUNCATED AT 250 WORDS)
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Blunt chest trauma can result in significant cardiothoracic injury, which can include cardiac contusion, aortic injury, and myocardial valvular injury. Nineteen patients with no prior history of cardiac abnormalities who sustained severe blunt chest trauma and had widening of the mediastinum on chest radiographs were prospectively evaluated using transesophageal echocardiography (TEE). In each instance TEE was performed without difficulty, excellent images were obtained of the aorta and heart, and no complications were noted. ⋯ Tricuspid regurgitation was found in three (16%) patients, and aortic and mitral regurgitation in one (5%) patient each. Aortic wall hematomas were seen in two patients, one of whom had an intimal tear on aortography, and a pericardial effusion was seen in one patient with an aortic intimal tear confirmed angiographically. Thus TEE can be performed safely in the acute setting of patients sustaining severe blunt chest trauma and yield useful information with respect to cardiovascular function and the aorta.
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The study reported here sought to identify a group of adult head injury patients in whom computerized axial tomographic (CT) scans were not necessary. The study was limited to patients 18 years of age and older with a history of minor head injury who remained neurologically stable for 20 minutes after arrival at the trauma center, maintained a Glasgow Coma Scale score of at least 13, and had no clinical evidence of basal skull fracture. ⋯ Of a total of 348 patients studied, 12 had an abnormal CT scan with no neurologic deficits or sequelae, and all of them had an uneventful hospital discharge without readmission. It appears that a routine CT scan for minimal head injury patients is an inefficient use of personnel and equipment which may add to the ever increasing financial burden on trauma centers.
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The regionalization of trauma care has led to a decrease in preventable death after injury. This decrease has been attributed to earlier resuscitation and surgical intervention. Little emphasis, however, has focused on the critical care phase of trauma patient management. ⋯ The proportion of preventable deaths attributable to CCEs was higher than the proportion of preventable death attributable to errors in the resuscitative and operative phases of care (p less than 0.001, chi-square). These data indicate that CCEs significantly contribute to preventable mortality and morbidity in trauma patients. It is imperative that physicians caring for trauma patients possess expertise in the critical care management of injured patients.