J Trauma
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The purpose of this study is to compare techniques for the diagnosis of suspected ventilator-associated pneumonia in the trauma patient. Per the literature, bronchoscope protected brushings and bronchoalveolar lavage were set as the standards for comparison because of their high specificity and sensitivity. We hypothesized that blind protected brushings were equivalent to bronchoscope-directed techniques and that endotracheal aspirates (ETA) were not. ⋯ A quantitative analysis of bacteriologic cultures obtained by four standard sampling techniques has demonstrated with statistical significance that no difference exists between modality of sampling in reliability or in obtaining clinically significant pathogens. In reviewing the literature, this study is the first assessment of agreement for cultured pathogens between the four different sampling modalities and the largest to assess the efficacy of the blind protected brush technique.
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A variety of policy groups have recommended that screening and brief interventions (BIs) for alcohol disorders be widely implemented in health care settings. This study was conducted to determine the current status of screening and intervention programs in trauma centers and to evaluate specific barriers to implementation of screening and BIs. The hypotheses tested were that surgeons who support screening and brief interventions would be less likely to endorse the purported barriers to screening and intervention and would have a better understanding of the concept of brief interventions. ⋯ Trauma surgeons are screening for alcohol disorders more frequently than they were 5 years ago. Barriers to screening are not as prevalent as previously reported. Support for implementing screening and intervention programs depends on whether surgeons believe trauma centers are appropriate sites for addressing alcohol disorders, whether surgeons believe patients with alcohol problems should be referred for professional treatment, whether surgeons understand the concept of brief interventions, and whether they believe the cost constraints are not prohibitive. Widespread education in the effectiveness and methods of BIs would facilitate implementation of alcohol screening and intervention programs to help reduce recurrent alcohol-related injury.
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The purpose of this comparative cadaveric study was to investigate whether the stability of partially unstable pelvic fractures can be improved by combining plate fixation of the symphysis with a posterior sacroiliac screw. ⋯ The addition of a sacroiliac screw in a Tile B1 fracture does not provide significant additional stability. Although cyclic loading was not tested, in these experiments forces could be applied that were similar to full body weight. Clinical experiments into direct postoperative weight bearing are recommended to examine the clinical situation.
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Automated blood pressure (BP) determinations by oscillometry are reported to be as accurate as invasive monitoring for systolic pressures as low as 80 mm Hg. Automated BP devices are widely used by prehospital providers and in hospital operating rooms, emergency departments, and intensive care units, although the accuracy of automated BP has not been demonstrated in trauma patients. We hypothesized that automated BP is less accurate than manual BP in trauma patients. The purpose of this study was to determine the accuracy of automated BP versus manual BP in trauma patients. ⋯ Injury severity, degree of acidosis, and resuscitation volume were more accurately reflected by manual BP. Automated BP determinations were consistently higher than manual BP, particularly in hypotensive patients. Automated BP devices should not be used for field or hospital triage decisions. Manual BP determinations should be used until systolic blood pressure is consistently > or = 110 mm Hg.