J Trauma
-
Many new types of expanding or fragmenting handgun ammunition have been developed. Knowledge of these unusual bullets may aid in the management of patients and their wounds. ⋯ Expanding/fragmenting bullets produce larger, shallower wounds than do full metal jacketed bullets. Recognition of the wound and roentgenographic appearances of these unusual bullets will help the trauma surgeon to properly treat gunshot victims. Because of the occurrence of jacket separation in water, ordnance gelatin should be used for optimal evaluation of bullet performance.
-
Comparative Study
Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.
The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information influences subsequent therapeutic decisions on the early management of severely injured patients. ⋯ TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualzing lung contusions, pneumothorax, and hemothorax. Early TCT influences therapeutic management in a significant number of patients. We therefore recommend TCT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.
-
Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.
To review the success rate of embolization in stopping hemorrhage for unstable patients with severe pelvic fractures, to calculate the time to achieve embolization, and to determine the yield from angiography. ⋯ Only a small percentage of patients with pelvic fractures require embolization, but when it is used, embolization can be 100% effective. Age, time to achieve embolization, and initial hemodynamic instability appear to be important factors in survival.
-
Comparative Study Clinical Trial
Effect of alcohol on the utility of base deficit in trauma.
Base deficit (BD) is an indicator of metabolic acidosis and is used as an index of shock and resuscitation for trauma patients. Ethanol causes an increase in lactate production and may cause metabolic acidosis in otherwise normal patients. The effects of alcohol on BD have not been investigated. This study was performed to determine the effects of ethanol on the utility of BD for assessing shock and resuscitation among trauma patients. ⋯ Ethanol can contribute significantly to metabolic acidosis among trauma patients and may confound the utility of BD to some degree. There was no difference in intensive care unit or overall length of stay, however, regardless of ethanol level, and the majority of patients with a BD < or = -6 still required transfusion. Even in the presence of ethanol, a BD < or = -6 remains a powerful indicator of major injury, increased length of stay, and transfusion requirement.
-
Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States. ⋯ Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.