J Trauma
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We conducted a prospective study in patients with multiple injuries investigating the time course of trauma-related changes of systemic immunologic defense mechanisms. ⋯ In patients who died of severe trauma and in whom the cause of death was multiple organ failure, a significantly lower production of antiendotoxin antibodies was measured shortly before death. An insufficient immune defense (dysergy) may be involved in the pathomechanisms leading to the development of organ dysfunction.
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Trauma care delivery in Canada, even in major trauma centers, usually devolves to the most involved service. For patients with multisystem injuries, this is not always optimal and aspects of care outside the domain of the primary service are apt to be overlooked. Trauma care is necessarily multidisciplinary, and to be optimal, appropriate integration of the care process and prioritization are required. The purpose of this study was to examine the impact on care in a busy provincial trauma center, after the introduction of a trauma program with a clinical trauma service, revised trauma protocols, and a dedicated trauma unit. ⋯ Trauma care improvement can be achieved by a multidisciplinary team focusing on the process of care, developing a dedicated trauma service to manage the more seriously injured patients, collecting them onto a single unit, and initiating program management.
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Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation. ⋯ We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.
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In this article, we present our experience of group lightning injury. Individual injuries are most common after single strikes. ⋯ Although injured under the same circumstances, these patients presented with a wide range of symptoms and signs. We also describe a characteristic burn pattern, the "tip-toe sign."
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The optimal method of evaluating blunt abdominal trauma remains controversial. A combination of a sensitive screening test, diagnostic peritoneal lavage (DPL), and a specific test, abdominal computed tomography (CT), may be a safe, efficient approach to adult blunt abdominal trauma. ⋯ Screening DPL, followed by abdominal CT if positive, is a safe, efficient method of evaluating adult blunt abdominal trauma that reduces the time required to evaluate the abdomen, does not result in increased nontherapeutic celiotomies, results in fewer missed injuries, and reduces the overall use of abdominal CT.