J Trauma
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Comparative Study
Training residents using simulation technology: experience with ultrasound for trauma.
The need for surgeons to become proficient in performing and interpreting ultrasound examinations has been well recognized in recent years, but providing standardized training remains a significant challenge. The UltraSim (MedSim, Ft. Lauderdale, Fla) ultrasound simulator is a modified ultrasound machine that stores patient data in three-dimensional images. By scanning on the UltraSim mannequin, the student can reconstruct these images in real-time, eliminating the need for finding normal and abnormal models, while providing an objective method of both teaching and testing. The objective of this study was to compare the posttest results between residents trained on a real-time ultrasound simulator versus those trained in a traditional hands-on patient format. We hypothesized that both methods of teaching would yield similar results as judged by performance on the interpretive portion of a standardized posttest. It is designed as a prospective, cohort study from two university trauma centers involving residents at the beginning of their first or second postgraduate year of training. The main outcome measure was performance on a standardized posttest, which included interpretation of ultrasound cases recorded on videotape. ⋯ The use of a simulator is a convenient and objective method of introducing ultrasound to surgery residents and compares favorably with the experience gained with traditional hands-on patient models.
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Practice Guideline Guideline
Scandinavian guidelines for initial management of minimal, mild, and moderate head injuries. The Scandinavian Neurotrauma Committee.
The Scandinavian Neurotrauma Committee was initiated by the Scandinavian Neurosurgical Society to develop evidence-based guidelines for improved care of neurotrauma patients. ⋯ The Scandinavian Neurotrauma Committee suggests guidelines that should be safe and cost-effective for the initial management of minimal, mild, and moderate head injuries.
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Comparative Study
Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.
Thoracic aortic injury (TAI) is a devastating condition in which prompt recognition can obviate morbidity and mortality. It is a long-held belief that TAI is more likely when there is a "major mechanism of injury." The purposes of this prospective study were to determine mechanism characteristics that are predictive of TAI and to evaluate chest computed tomography (CT) as a screening tool for TAI. ⋯ Considering the inherent difficulties in identifying patients at risk for TAI and the effectiveness of chest CT as a screening tool for aortic injury, we recommend liberal use of chest CT in blunt chest trauma. Guidelines for determining the need for aortic imaging are outlined.
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Comparative Study Clinical Trial
Effect of prehospital advanced life support on outcomes of major trauma patients.
Determine whether prehospital advanced life support (ALS) improves the survival of major trauma patients and whether it is associated with longer on-scene times. ⋯ ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.
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Comparative Study
Intrathoracic blood volume as an end point in resuscitation of the severely burned: an observational study of 24 patients.
Treatment of burn shock according to empirical resuscitation formulas is still considered the gold standard, and the burn community does not advocate the use of invasive cardiorespiratory monitoring in general. As a consequence, data dealing with early postburn hemodynamics are sparse, and only few studies have paid attention to the topic of end-point burn shock resuscitation. However, recent studies have suggested that burn survival may be improved when invasive monitoring is used to guide fluid therapy during the shock phase. ⋯ ITBV may be a reliable preload indicator to guide volume therapy in life-threatening burns, and end-point-fixed resuscitation to this parameter seems to be associated with significantly higher fluid administration than calculated compared with traditional burn formulas. The effects of burn resuscitation to fixed end points on survival and multiple organ failure should be evaluated in future randomly assigned trials.