J Trauma
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To evaluate the procedure time, complications, and percutaneous dilational tracheostomy (PDT) charges. ⋯ Surgeons can rapidly perform PDT at the bedside with a lower risk of complications than open tracheostomy and at a significantly reduced patient charge.
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Polyvalent antivenin remains the most recommended treatment of crotalid envenomation, including copperhead snakebites. Because of the significant morbidity associated with antivenin therapy, some have proposed conservative therapy for less serious envenomations. Few if any studies have separated the treatment of the less serious copperhead bite from the more serious bite of a rattlesnake or a water moccasin. ⋯ Conservative treatment resulted in no deaths, limb loss, or residual disability. The mean hospital stay was 2.15 days compared with 3.9 days in patients with systemic symptoms. These data support a conservative approach to most copperhead envenomations and suggest that the treatment for copperhead bites should be segregated from the more serious rattlesnake and water moccasin snakebites.
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Three cases of successful prehospital resuscitation of blunt trauma patients sustaining cardiac arrest resulting from ventricular fibrillation are reported. Although probably uncommon, ventricular fibrillation not caused by severe hypovolemia, exsanguination, or severe hypoxia in the setting of blunt trauma might be a treatable cause of cardiac arrest. Early electrocardiographic monitoring of patients with blunt trauma, including those with cardiac arrest, can detect this small, yet easily salvageable group of patients.
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Comparative Study
Analysis of quality of life in polytraumatized patients two years after discharge from an intensive care unit.
Analysis of quality of life of polytraumatized critical care patients. ⋯ Polytraumatized patients admitted into ICU showed a worsening of their quality of life 1 and 2 years after ICU discharge, with an improvement between 1 and 2 years. Quality of life after 2 years is influenced by age, severity of illness, and previous quality of life.
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Comparative Study
Hemodynamic, plasma volume, and prenodal skin lymph responses to varied resuscitation regimens.
The theoretical efficacy of hypertonic saline (HS) resuscitation for hemorrhagic shock purportedly stems from the osmolar extraction of intracellular fluid into the plasma. This hypothesis presumes a concomitant expansion of the interstitial fluid space. Colloid resuscitation, in theory, expands the plasma volume by extracting interstitial fluid. ⋯ Wet/dry skin ratios were greatest at 60 minutes in the LR group but similar at 120 minutes in all four groups. These data suggest that interstitial fluid space remains contracted during the first hour after HS, HSD, and Dex resuscitation compared with LR resuscitation, even though the restoration of plasma volume, MAP, and cardiac output is greatest with the Dex regimen. Further studies with total body water and intracellular water are needed in this model.