J Trauma
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Abdominal computed tomographic (CT) scans are used in the evaluation of blunt trauma. The purpose of this study was to determine if isolated intraperitoneal fluid seen on CT scan necessitates laparotomy. ⋯ Exploratory laparotomy was therapeutic in 94% of patients. Isolated intraperitoneal fluid on CT scan after blunt trauma mandates laparotomy.
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Clinical Trial Controlled Clinical Trial
Effect of the Advanced Trauma Life Support program on medical students' performance in simulated trauma patient management.
Part of the senior medical students' examination at the University of Toronto involves testing with simulated patient management. We compared the performance in these simulations of senior medical students who received Advanced Trauma Life Support (ATLS) training with those who did not receive ATLS training. ⋯ The ATLS course, both complete and audit status, prepares students more appropriately for managing trauma patients as judged by trauma simulation scenarios. Consideration should be given for including ATLS as an integral part of the senior medical student curriculum.
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Comparative Study
Preferential benefit of implementation of a statewide trauma system in one of two adjacent states.
Implementation of Oregon's trauma system was associated with a reduction in the risk of death for hospitalized injured patients. An alternative explanation for improved outcome, however, is favorable concurrent temporal trends, e.g., new technologies and treatments. ⋯ Assuming that the two states demonstrated similar concurrent temporal trends, the findings support the conclusion that improved outcomes among injured patients in Oregon may be attributed to the institution of a statewide trauma system.
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Recent attention concerning the adverse outcomes of blood transfusion has resulted in decreased blood product usage for nonemergency care. We hypothesized that there has also been a decrease in blood product use in the management of seriously injured adults. ⋯ Between 1991 and 1995 there have been significant reductions in both the number of trauma patients receiving blood products and the total number of units transfused. These findings may reflect lower or abandoned hemoglobin transfusion triggers and increased awareness of complications related to transfusion.
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Recent studies have questioned the use of aggressive fluid resuscitation after uncontrolled arterial hemorrhage until the bleeding is controlled. However, it remains unknown whether resuscitation after hemorrhage from a venous origin (usually nonaccessible to surgical intervention) has any beneficial or deleterious effects on regional perfusion. The aim of this study, therefore, was to determine whether increased volume of fluid resuscitation after uncontrolled venous hemorrhage improves hemodynamic profile and regional perfusion in various tissues. ⋯ Fluid resuscitation after uncontrolled venous bleeding transiently increased cardiac output and mean arterial blood pressure compared with nonresuscitated animals. Moderate fluid administration, i.e., 10 mL, however, did increase total hepatic blood flow. In contrast, increasing the resuscitation volume to 30 mL did not improve hemodynamic parameters or regional perfusion. Thus moderate instead of no resuscitation or larger volume of resuscitation is recommended in an uncontrolled model of venous hemorrhage.