J Trauma
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To identify computed tomographic-detected intracranial hemorrhage (CTIH) risk factors and outcome in mild cognitive impairment (MCI) blunt trauma patients. ⋯ In mild cognitive impairment patients triaged directly to a Level I trauma center, age, arrival GCS score, and cranial soft tissue injury are risk factors for CT-detected intracranial hemorrhage. Neurologic deterioration and death are infrequent. These data strongly suggest that observation and discretionary brain CT imaging are a rational approach for blunt-injury mild cognitive impairment.
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This study summarizes all 2,550 trauma-related rural ambulance trip reports filed for the period January 1 through December 31, 1991 from the 12 rural counties surrounding Augusta, Georgia. There were 13.1 trauma-related ambulance runs per 1,000 population. Nearly one third of all rural ambulance runs are trauma related. ⋯ Only 51.5% of runs had a rural hospital as a destination, 14.2% went directly to a trauma center, and nearly 20% to another urban hospital. Of the 71 severe trauma cases received by ambulance, rural hospitals transferred out only 13 cases, most of these to the regional trauma center. Of the 47 trauma cases transferred to the trauma center, 33 were not severe.
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Nitric oxide synthase (NOS) inhibition has been shown to potentiate lipopolysaccharide (LPS) associated pulmonary hypertension, which may worsen right ventricular (RV) dysfunction and decrease cardiac output during sepsis. This study evaluates whether inhaled nitric oxide can ameliorate the adverse cardiopulmonary effects of NOS inhibition during endotoxemia. ⋯ Inhaled nitric oxide reverses pulmonary hypertension seen with L-NAME treatment during endotoxemia and may be a useful adjunct to NOS inhibition in the treatment of septic shock.
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To determine the relationship between the prognosis of seriously injured patients requiring emergency surgery and intraoperative end-tidal CO2 variables and "excess Pco2." ⋯ Values derived from the end-tidal CO2 and the excess Pco2 should be monitored intraoperatively in critically injured patients. Efforts should be made to improve cardiac output and adjust ventilation to maintain an end-tidal Pco2 of 25 mm Hg or more, an arterial to end-tidal CO2 difference of 12 mm Hg or less, and an excess Paco2 of 1.0 mm Hg or less.
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To develop a quantitative severity stratification within the framework of a Physiologic State Classification (PSSC) system that can be applied to critically ill post-trauma patients with "sepsis/SIRS" and to relate PSSC to the nature of the plasma cytokine response. ⋯ PSSC allows classification of the physiologic and cytokine mediator response to trauma and permits stratification of severity in posttrauma critical illness.