J Trauma
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days.
The purpose of this study was to compare the safety and therapeutic efficacy of a 24-hour versus 5-day course of ampicillin/sulbactam for the prevention of postoperative infections in high-risk patients sustaining hollow viscus injury from penetrating abdominal trauma. ⋯ High-risk patients with colon or other hollow viscus injuries from penetrating abdominal trauma are at no greater risk for surgical-site or nonsurgical-site infection when treated with only a 24-hour course of a broad-spectrum antibiotic.
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To determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head. ⋯ C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.
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Although depression in hepatocellular function occurs early after trauma and severe hemorrhage and persists despite fluid resuscitation, it remains unknown whether reactive oxygen species (ROS) play any role in the initiation of hepatocellular depression and damage under those conditions. We hypothesized that administration of a ROS scavenger at the beginning of resuscitation will attenuate organ injury after severe shock. ⋯ Our data suggest that ROS play a role in producing the depression in organ functions after severe hemorrhagic shock. Thus, adjuncts that attenuate the detrimental effects of ROS may be useful for improving the depressed cardiac and hepatocellular functions after trauma hemorrhage and resuscitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management.
Lung isolation and preservation of normal lung are the first lines of therapy in life-threatening massive hemoptysis. If bleeding continues but the side of origin is uncertain, use of a double-lumen tube (DLT) is reasonable. Utilizing a blind method to locate the bronchial cuff of a left-sided DLT without using any instrument, a DLT (Broncho-Cath, Mallinckrodt Medical Ltd., Athlone, Ireland) was successfully positioned without delay in a patient with massive hemoptysis, where auscultation could be misleading or useless and fiberoptic bronchoscope (FOB) was inapplicable. This study was performed to discern whether this blind method could substitute for FOB verification or auscultation in most circumstances where these two methods are unavailable or inapplicable. ⋯ This method, which requires no specific instrument and no time-consuming technique, can be taught easily and may be used in a situation where the rapidity of lung isolation or collapse is the key to saving life. We conclude that this blind method can be an alternative to the FOB and/or auscultation for the positioning of DLT in an emergency situation.