J Trauma
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Comparative Study
Comparison of nonbronchoscopic techniques with bronchoscopic brushing in the diagnosis of ventilator-associated pneumonia.
To determine the diagnostic accuracy of quantitative cultures obtained via nonbronchoscopic protected specimen brushing (PSB) and nonbronchoscopic bronchoalveolar lavage (BAL) compared with quantitative cultures obtained by bronchoscopic PSB in surgical patients suspected of ventilator-associated pneumonia. ⋯ Nonbronchoscopic PSB and BAL provide similar microbiologic data to bronchoscopic PSB in the diagnosis of ventilator-associated pneumonia while shortening procedure time significantly.
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To evaluate whether aeromedical transport of trauma patients who sustain an out-of-hospital cardiac arrest (OHCA) is justified. ⋯ These results suggest that: (1) trauma patients who are resuscitated to a sinus rhythm after OHCA should be transported to a trauma center; (2) Revised Trauma Score and Injury Severity Score are useful to predict survival; and (3) neurologic outcome is not accurately predicted by this model.
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The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. ⋯ Implementation of a two-tiered trauma response significantly decreased Emergency Department length of stay, allowed Emergency Medicine physicians to more rapidly identify, evaluate, and treat trauma patients requiring hospitalization, improved identification of patients requiring operating room or intensive care unit resources, and was time efficient and resource efficient.
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To describe the epidemiology of severe assault and gun injuries to children in an urban population and consider the impact of a comprehensive injury prevention program. ⋯ Comprehensive interventions may be effective in curbing the incidence of severe assault injuries to urban youth. Further controlled evaluations are needed to confirm the effectiveness of programs such as this and to better understand the prevention of violent injuries.
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Severe injury is frequently complicated by sepsis and organ failure. Activated neutrophils adherent to inflamed endothelia have been implicated in the pathogenesis of these complications. Identification of high-risk patients to target immunomodulatory therapy, however, remains an elusive goal. We postulated that (1) patients at risk for sepsis and organ failure could be identified by measuring shed selectin adhesions molecules as a marker of endothelial activation after injury and reperfusion, and (2) these elevated selectin levels would correlate with injury severity, shock, major complications, and mortality. ⋯ A subset of major trauma patients manifest increased levels of circulating E-selectin adhesion molecules after resuscitation. These patients seem to be at increased risk of death and possibly at risk for infections complications and organ failure. Selectin blockade is a potential new immunomodulatory strategy in this subgroup of patients.