J Trauma
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Thoracic trauma victims commonly sustain visceral pleural injury with resultant pneumothorax. These injuries usually respond to standard tube thoracostomy decompression and drainage. However, a subset of these patients develop recurrent and/or loculated pneumothoraces or pneumatoceles that are not readily accessible by tube thoracostomy. Percutaneous catheter drainage of these collections provides a safe and reliable method of management in critically ill patients.
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Impalement occurs when a portion of the body is penetrated by a rigid object. These injuries incorporate aspects of both blunt and penetrating type injuries in that the object or the body at time of impact is traveling at relatively low velocity and the energy is dissipated over a short distance. ⋯ Evaluation of these injuries can be uniquely challenging. We present a case of impalement of the neck from an object previously unreported in the literature, a golf club shaft.
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Comparative Study
Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms.
To determine the sensitivity for detecting pelvic pathology and instability, roentgenograms and computed tomographic (CT) scans from 59 patients with pelvic injuries that had been admitted to a Level I trauma center were randomly reviewed by a orthopedic surgeon blinded to the study. Normal control roentgenograms and CT scans were included to decrease observer bias. The anteroposterior (AP) roentgenogram detected 66% of all pelvic injuries, 78% of those involving the anterior ring, and 53% of those involving the posterior pelvic ring. ⋯ The mechanism of injury could be ascertained with 73% sensitivity by plain films and with 79% sensitivity by inlet and outlet views; trauma CT scans were 96% and high-definition pelvic CT scans were 100% sensitive. When combined, the AP pelvis roentgenograms and trauma CT scans identified 96% of the injured structures and were 100% sensitive in determining injury force patterns and instability. The data suggested that a good quality AP pelvis roentgenogram in conjunction with a complete trauma CT scan of the abdomen/pelvis should identify both the injury mechanism and pelvic instability with a high degree of sensitivity.
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Motorcycle drivers have the highest frequency of alcohol use among all road users. This study examines alcohol use among a large sample of injured motorcycle drivers and examines how crash characteristics differ with the use of alcohol. ⋯ Alcohol use remains a significant factor in motorcycle crashes and is an important area for injury prevention efforts.
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Critical care consumes a significant portion of health care costs. Although there are currently increasing pressures to limit expenditures, data are not always available to allow physicians and patients to make informed therapeutic or triage decisions regarding prolonged intensive care unit (ICU) stays. The purpose of this study was to evaluate long-term outcome, quality of life, and charges in surgical patients requiring prolonged ICU stays (> 14 days). ⋯ In this population, prolonged ICU stays resulted in acceptable quality of life and a relatively high survival rate despite significant economic investment. This study does not support withdrawal of therapy or triage decisions based solely or primarily on age or length of ICU stay.