J Trauma
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Long-term outcomes after blunt trauma remain poorly defined. The purpose of this study was to document such outcomes in extremely injured adults (Injury Severity Score > or = 50). From April 1990 to June 1993, 76 patients (5% of all trauma victims) had an ISS > or = 50 at a single trauma center. ⋯ After a mean follow-up of 27 months, 6% had died, 9% refused participation, and the remaining 30 patients (91% of long-term survivors) demonstrated significant residual disabilities in physical, emotional, and mental health status. We suggest that extremely injured patients comprise a small proportion of blunt trauma victims, consume substantial acute care hospital resources, often survive, and yet frequently have residual disability. A reduction in this long-term disability may represent the greatest challenge in modern trauma care.
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We conducted a retrospective review to determine the early effects of implementing the American College of Surgeons (ACS) level II criteria on the number of transferrals and survival rates of trauma patients in a rurally based hospital. Data were collected from time period "B" (13 months before) and time period "A" (14 months after) implementing ACS criteria. Patient data parameters included age, sex, Revised Trauma Score, Glasgow Coma Scale score, Injury Severity Score, number of days hospitalized, diagnoses, place of injury (i.e., local county or transfer from another county), outcome, and probability of survival. ⋯ A much higher percentage of these patients were transfers from out of county (period B = 33% vs. period A = 59.5%, p = 0.0001). Despite a higher percentage of transferred patients with probability of survival < or = 25% (period B = 25% vs. period A = 58%, p = 0.002), the survival rate in this group improved from 7.5% during time period B to 25.5% after implementing level II criteria (p = 0.0303). This data suggest that implementing level II ACS guidelines has the early beneficial effects of increasing transfers of seriously injured patients and improving survival in the most critically injured group.
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Tension pneumothorax and hemothorax are life-threatening emergencies that require immediate treatment. Field stabilization of trauma patients often requires rapid surgical drainage of these injuries but inevitably delays departure for hospital. Conventional treatment involves the insertion of a chest drain but we describe a modified technique of simple thoracostomy that is faster and simpler to perform and avoids the risks associated with insertion of the chest drain. Following use of a simple thoracostomy as an alternative to chest drain insertion in 45 patients at the roadside, this technique appears to have important advantages over conventional techniques and warrants further clinical evaluation.
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Comparative Study
Diaspirin cross-linked hemoglobin resuscitation of hemorrhage: comparison of a blood substitute with hypertonic saline and isotonic saline.
Resuscitation with tiny volumes of hypertonic solutions rapidly restores tissue perfusion while minimizing edema after hemorrhage and tissue trauma. ⋯ DCLHb restored mean arterial pressure and ameliorated the development of flow-dependent oxygen consumption. Base deficit, a reflection of systemic oxygen debt, was minimized with this blood substitute. DCLHb may represent a superior small volume resuscitative fluid after trauma and hemorrhage.