J Trauma
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Comparative Study
Trauma care systems in urban Latin America: the priorities should be prehospital and emergency room management.
Trauma is a significant cause of premature death in developing nations, but financial resources to deal with it are extremely limited. To determine which segments of a developing nation's trauma system would be most amenable to improvements, we compared management and outcome of all seriously injured patients (Injury Severity Score of > or = 9 or died) treated over 1 year by the trauma systems associated with an urban hospital in Latin America, Regional Trauma Center 21 (n = 545) in Monterrey, Mexico, and a level I trauma center in the United States, Harborview Medical Center (n = 533) in Seattle, Wash. Mortality was higher in Monterrey (55%) than in Seattle (34%, p < 0.001), because of a preponderance of prehospital and emergency room (ER) deaths. ⋯ Scene and transport times were < 30 minutes for 47% of Monterrey cases vs. 75% in Seattle (p < 0.001). For patients with arrival blood pressure < 80, prehospital intubations had been performed on 5% of Monterrey patients vs. 79% in Seattle (p < 0.001) and en route fluid resuscitation administered to 70% of Monterrey patients vs. 99% in Seattle (p < 0.001). The observed mortality patterns indicate that priorities for trauma system improvement in urban Latin America should focus on more rapid prehospital transport and improved en route and ER resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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The presentation, diagnosis, and successful management of posttraumatic pseudoaneurysms of the intraparenchymal splenic artery after nonoperative therapy in an adult patient is described. Pseudoaneurysm formation of the intraparenchymal splenic artery is a rare complication of traumatic splenic injury, which is a potential mechanism of delayed splenic rupture and demonstrates the importance of follow-up in the nonoperative therapy of blunt injury to the spleen.
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Blunt injuries to the gallbladder are very uncommon, whereas penetrating gallbladder trauma occurs more frequently. Over the last 19-year period through 1994, 22 cases with blunt gallbladder trauma were treated. Avulsion (partial or complete) and contusion were observed in 10 cases each (45%). ⋯ Associated intra-abdominal trauma was present in 100% of the cases and accounted for both mortalities. Gallbladder injury was diagnosed after celiotomy, except for one case that was diagnosed and treated nonoperatively. Based on the experiences gained herein and an extensive review of the literature, a classification scheme for gallbladder trauma and its treatment is presented.
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The purpose of this study was to determine the effect of inhaled nitric oxide (NO) on oxygenation, hemodynamics, and ventilation in patients with adult respiratory distress syndrome (ARDS). ⋯ Inhaled NO improves oxygenation and pulmonary hemodynamics in patients with ARDS. However, the improvement to NO is variable.
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Injuries to the portal triad are a rare and complex challenge in trauma surgery. The purpose of this review is to better characterize the incidence, lethality, and successful management schemes used to treat these injuries. ⋯ Injuries to the anatomical structures of the portal triad are rare and often lethal. Intraoperative exsanguination is the primary cause of death, and hemorrhage control should be the first priority. Bile duct injuries should be identified by intraoperative cholangiography and repaired primarily or by enteric anastomosis; lobar bile ducts can be managed by ligation.