J Trauma
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The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming. ⋯ Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
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Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed. ⋯ Flexion-extension studies were not a cost-effective part of the protocol, and they were dropped.
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Clinical Trial
Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption.
Surgical reconstruction is usually indicated for distal clavicle fractures with coracoclavicular ligament disruption due to a high rate of nonunion and delayed union. We report the outcome of a surgical technique for this type of fracture. ⋯ The advantages of this technique include that the disrupted coracoclavicular articulation is rigidly restored and then the fracture site can be easily reduced and fixed with a wire. This technique allows for stable fixation with early mobilization and early return to work and sports.
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This study correlated isolated, blunt liver or spleen injury with the presence, location, and amount of free fluid in the pediatric blunt trauma patient. ⋯ There is a direct correlation between the severity of the isolated injury and the likelihood and volume of associated free fluid. The pelvis was the most common location to detect free fluid and had the greatest estimated fluid volume.
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The Institute of Medicine has recommended intraosseous (IO) infusion of 7.5% hypertonic saline (HTS) for combat casualties in shock. We tested the safety and efficacy of this recommendation in a long-term survival model of uncontrolled hemorrhagic shock using dehydrated swine. ⋯ HTS resuscitation effectively restored hemodynamic stability in dehydrated swine without increased bleeding from an uncontrolled vascular injury. However, IO infusion of HTS in this model was associated with a very high rate of local complications. Further investigations should be undertaken before IO use of 7.5% HTS in humans.