J Trauma
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Apoptosis in organs of rats in early stage after polytrauma combined with shock was researched. ⋯ Apoptosis was induced in thymus, spleen, liver, lung, and intestine in early stage after polytrauma combined with shock, which may play partial roles in the development of multiple organ failure.
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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). ⋯ In this pilot study, StCO2 correlated significantly with CPP. A StCO2 > or = 75 suggests that CPP is adequate, while < 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
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This study assessed patients with traumatic brain injury (TBI) to determine whether prehospital and community hospital providers employed hyperventilation therapy inconsistent with consensus recommendation against its routine use. ⋯ Prehospital and community hospital hyperventilation practices are not consistent with consensus recommendations for limitation of hyperventilation therapy.
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Little research has examined trauma outcomes in the very elderly (>80 years), the fastest growing subset of our geriatric population. Our objective was to describe demographics, mechanism of injury and injury severity of very elderly trauma patients and examine the association between trauma center (TC) verification and hospital mortality in this age group. ⋯ Risk-adjusted outcomes, in this population, differed between TC and AC settings. Head injury, injury severity, and lack of TC verification are associated with hospital mortality in very elderly trauma patients.
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The 372 cases of crush syndrome that followed the 1995 Hanshin-Awaji earthquake have provided a unique opportunity to investigate the long-term physical outcomes and to establish indications for specific treatments in such patients. The objectives of this study were to identify independent predictors of physical outcome in patients suffering from crush syndrome and to clarify the influence of fasciotomy on outcomes. ⋯ Secondary compartment syndrome affects physical outcome in crush syndrome patients. We obtained no evidence that fasciotomy improves outcome. Delayed rescue, delayed fasciotomy, and radical debridement may worsen the physical prognosis. Indications for fasciotomy in crush syndrome during the acute phase need further deliberation.