J Trauma
-
Knee dislocation, which poses a significant risk for injury of the popliteal artery, prompts many surgeons to evaluate these patients with arteriography routinely. Our hypothesis was that physical examination alone (without arteriography) accurately confirms or excludes surgically significant vascular injuries associated with knee dislocation. ⋯ This limited series suggests that the presence or absence of an injury of the popliteal artery after knee dislocation can be safely and reliably predicted, with a 94.3% positive predictive value and 100% negative predictive value. Arteriography appears to be unnecessary when physical examination is negative but may avert negative vascular exploration when physical examination is positive. This approach substantially reduces cost and resource use without adverse impact on the patient.
-
Traditional criteria for trauma team activation (TTA) include hypotension, tachycardia, tachypnea, and unresponsiveness. In a recent revision of the Resources for Optimal Care of the Trauma Patient, gunshot wound to the trunk (GSWT) was recommended as an independent criterion for major resuscitation and TTA. To validate this suggestion, we reviewed records of patients with GSWT to see if patients not meeting standard TTA criteria had serious injuries that would benefit from TTA. ⋯ Patients with GSWT often require high-level care, even when physiologic TTA criteria are absent on admission. Gunshot wound to the trunk should be an independent criterion for TTA.
-
As the U.S. population ages, the number of geriatric trauma victims will continue to grow. Outcomes are known to be worse for these patients, in large part because of preexisting conditions (PECs). The specific impact of various PECs on outcome in geriatric trauma has not been well studied because of heterogeneous data sets and sample sizes. ⋯ Considered independently, these data are insufficient to allow withdrawal of care, but this information may be a useful component to help in guiding families faced with difficult decisions after geriatric trauma.
-
Using a standardized massive splenic injury (MSI) model of uncontrolled hemorrhagic shock, we studied the effect of continuous fluid resuscitation and splenectomy on the hemodynamic response and survival in rats. ⋯ Continuous infusion of large-volume RL and splenectomy after massive splenic injury resulted in a significant increase in intra-abdominal bleeding and shortened survival time compared with small-volume RL infusion.