J Trauma
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In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. ⋯ The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.
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To quantify pulmonary contusions on chest x-ray film and to evaluate factors correlating with the size of the pulmonary contusions, changes in the first 24 hours, the need for ventilatory assistance, and death. ⋯ Quantifying and noting changes in the extent of the pulmonary contusions and PaO2/FIO2 ratio during the first 24 hours may be of value in determining the need for ventilatory assistance and predicting outcome.
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The current literature defines the costs of trauma care in terms of hospital costs and charges. We sought to define the qualitative and quantitative labor costs of trauma care by measuring the various components of bedside care provided by surgeons at a community hospital. ⋯ A significant labor cost (TT) was required for the care of blunt trauma patients, and the majority of that cost was not spent in the operating room but involved the performance of cognitive services. Significant correlation existed between ISS and labor cost. The presence of ethanol intoxication significantly increased this commitment. These data might be of use in creating provider reimbursement schemes for trauma care. This methodology may have applications in the design of hospital systems for trauma care.
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Case Reports
Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury.
We have reported a unique case of esophageal entrapment and obstruction from a thoracic spine hyperextension-dislocation injury after a motor vehicle crash. Because the risk for esophageal injury is not typically associated with thoracic spine injury, a heightened sensitivity for developing symptoms and signs is at least necessary. As with any injury to the gastrointestinal tract, optimal therapy requires resuscitation and prompt operative intervention.
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Randomized Controlled Trial Comparative Study Clinical Trial
Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen.
Airway management takes precedence regardless of what type of life support is taking place. The gold standard for airway control and ventilation in the hands of the experienced paramedic remains unarguably the endotracheal tube. Unfortunately, laryngoscopy and endotracheal intubation require a skilled provider who performs this procedure on a frequent basis. Special Operations corpsmen and medics receive training in the use of the endotracheal tube, but they use it infrequently. The use of alternative airways by Navy SEAL and Reconnaissance combat corpsmen has not been evaluated. Our objective was to compare the ability of Special Operations corpsmen to use the endotracheal tube (ETT), laryngeal mask airway (LMA), and esophageal-tracheal combitube (ETC) under combat conditions. ⋯ The Special Operations corpsmen easily learned how to use the ETC and LMA. In this study, they showed the ability to appropriately use the ETT as well as the ETC and LMA. For SEAL corpsmen, the alternative airways should not replace the ETT; however, on occasion an advanced combat casualty care provider may not be able to use the laryngoscope or may be unable to place the ETT. The LMA and ETC are useful alternatives in this situation. If none of these airways are feasible, cricothyrotomy remains an option. Regardless of the airway device, refresher training must take place frequently.