J Trauma
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To compare differences in response times, scene times, and transport times by advanced life-support-trained paramedics to trauma incidents in urban and rural locations. ⋯ Response and transport times among professional, advanced life-support-trained paramedics responding to major trauma incidents are longer in rural areas, compared with urban areas.
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Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. ⋯ Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.
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Trauma has a high rate of recurrence, suggesting that some people are more injury-prone than others. This study was performed to evaluate some of the psychological and social factors that might influence the likelihood of traumatic injury. ⋯ Victims of trauma, both nonintentional, and especially intentional, have a high incidence of psychopathology. Victims of intentional trauma have significantly lower intelligence scores than either nonintentional injury or elective surgery patients. The high incidence of unemployment, alcohol abuse, and illicit drug use in victims of intentional injury might provide several opportunities for trauma prevention programs. Underlying psychological disorders will have to be addressed to reduce the likelihood of becoming a victim of trauma.
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Comparative Study
Effects of increasing airway pressure and PEEP on the assessment of cardiac preload.
Cardiac preload is most commonly assessed by pulmonary artery wedge pressure. It was postulated that the right ventricular end-diastolic volume index (RVEDVI) derived by thermodilution would be a better predictor of preload in trauma patients with high airway pressures associated with positive pressure ventilation and positive end-expiratory pressure. ⋯ Unlike the pulmonary artery wedge pressure, RVEDVI is as reliable indicator of preload in the mechanically ventilated trauma patient. This is especially true when the right ventricular ejection fraction is not severely depressed.
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Recent studies have suggested that transesophageal echocardiography (TEE) can be used as the primary imaging method in patients suspected of traumatic rupture of the thoracic aorta. A segment of the aorta and the aortic arch branches cannot be adequately evaluated in all patients by TEE. To assess the impact of these limitations of TEE, this retrospective study examined the aortographic features of traumatic aortic or great vessel injuries in a large number of patients. ⋯ Twenty percent of patients in our retrospective series had traumatic involvement of aortic arch branches or the distal ascending aorta. These vascular injuries may be suboptimally assessed or overlooked if TEE is used as the sole imaging modality in the evaluation of patients with blunt chest trauma.