J Trauma
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Ensuring an unobstructed airway and adequate oxygenation are first priorities in the resuscitation of the trauma patient. In situations of difficult endotracheal intubation, rapid sequence protocols frequently include the use of paralytic agents and cricothyrotomy for airway management. Recent literature findings suggest that the prehospital use of cricothyrotomy is too frequent. The purpose of this study was (a) to evaluate the efficacy of a rapid sequence intubation protocol without the use of paralytic agents, and (b) to determine the need for cricothyrotomy by using this protocol in the field. ⋯ Experienced emergency medical services personnel can effectively perform endotracheal intubation with narcotic analgesics without the use of paralytic agents in the field. With proper training for field airway management, cricothyrotomy in the field can be reduced to a few indications with high success rates.
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To evaluate the functional outcome and return to work after suture of upper extremity nerves after low-velocity missile injury. ⋯ Nerve suture between the wrist and axilla and supplemental techniques achieve functional recovery in the majority of patients after missile injury with good expectations for return to work, except in combined median and ulnar nerve injuries.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Partial liquid ventilation decreases the inflammatory response in the alveolar environment of trauma patients.
Perflubron is a perfluorocarbon with unique physical characteristics. It has twice the density of water, allows free diffusion of O2 and CO2, is easily dispersed, and is insoluble. Thus, it can act as "liquid positive end-expiratory pressure" to recruit collapsed alveoli and improve oxygenation. Results of laboratory studies suggest that perflubron exerts an anti-inflammatory effect on alveolar cells. Limited clinical data in neonates and adults with severe acute respiratory distress syndrome are promising. We present a single institution's experience with partial liquid ventilation (PLV) in trauma patients compared with conventional mechanical ventilation (CMV) with particular attention to the alveolar inflammatory response. ⋯ Early institution of partial liquid ventilation is effective at reducing the alveolar inflammatory response. Perflubron exhibits an anti-inflammatory effect in the alveolar environment with reduction of proinflammatory IL-1 and IL-6 (possibly removing a stimulus for IL-10), white blood cell count, and protein capillary leak. PLV also reduces alveolar neutrophils independent of IL-8. Further characterization of this altered inflammatory response is necessary.
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Wide variances exist in reports of survival rates after penetrating cardiac injuries because most are hospital-based reports and thus are affected by the local trauma system. The objective of this study was to report population-based, as well as hospital-based, survival rates after penetrating cardiac injury. ⋯ Review of population-based studies indicates that there has been only a minor improvement in the survival rates for the treatment of penetrating cardiac injuries.
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Review Case Reports
Seat belt-related injury to the common iliac artery: case report and review of the literature.
Blunt trauma to the common iliac artery is a rare phenomenon. Although seat belt injuries to the abdominal aorta and the carotid artery have been reported, there is only one previous report in the literature of seat belt injury to the common iliac artery. We report a case of common iliac arterial injury directly related to use of the lap belt and not associated with pelvic or lumbar fractures. The literature related to blunt trauma of the common iliac artery is reviewed.