J Trauma
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The purpose of this study was to identify and analyze factors contributing to both airbag deployment and resulting head injuries (HIs) and to quantify the effect of airbag deployment on head injuries, in terms of odds of head injury and severity, in severe motor vehicle collisions (MVCs). ⋯ Airbag deployment did not significantly lower a driver's odds of head injury in a severe MVC, but it did significantly lower the severity of head injury. This is a significant finding, given that 72% of our study population sustained a head injury and the importance of lowering the severity of these head injuries in terms of patients' ultimate outcome. The most important factor associated with head injuries was ejection, which nearly doubled a driver's odds of head injury (odds ratio, 1.759; 95% confidence interval, 1.201-2.577). This reinforces the supplementary protective effect of an airbag and that "buckling up" and keeping occupants in the vehicle is of primary importance in the prevention of head injuries.
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Comparative Study
Comparison of 10 different hemostatic dressings in an aortic injury.
Uncontrolled hemorrhage is the leading preventable cause of death on the battlefield. Similarly, hemorrhage accounts for 80% of all deaths within the first 48 hours of injury in civilian trauma patients. New methods of hemostasis are required to reduce hemorrhagic mortality. The purpose of this study was to compare nine hemostatic dressings for their efficacy in controlling bleeding from an otherwise fatal aortic injury in a pig model. Each hemostatic dressing was compared with the current standard U.S. Army field gauze dressing for a 1-hour period. ⋯ With one 4-minute application, a single fibrin dressing stopped bleeding from an aortotomy, which was equivalent to sutured repair. No other test group exhibited any evidence of significant hemostatic efficacy.
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Clinical Trial
Influence of low tidal volumes on gas exchange in acute respiratory distress syndrome and the role of recruitment maneuvers.
BACKGROUND Use of a low tidal volume (V(T)) strategy in the treatment of acute respiratory distress syndrome can lead to a decrease in oxygenation. This study evaluated the safety and efficacy of a recruitment maneuver (RM) in this setting. ⋯ An RM transiently improves gas exchange during low V(T)ventilation. RMs are well tolerated and no hemodynamic consequences were seen.
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The utility of diagnostic peritoneal lavage (DPL) as a diagnostic tool specifically for shotgun wound to the abdomen (SGWA) is unknown. This prospective study was undertaken to determine the sensitivity, specificity, and accuracy of DPL for the detection of intra-abdominal injuries following SGWA. ⋯ For patients presenting with SGWA who do not present with indications for immediate laparotomy, DPL is a reliable indicator of intra-abdominal injury and need for operative intervention.
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Nuclear factor-kappa B (NF-kappa B) plays a critical role in the cellular response to a variety of stimuli, and it regulates the production of various inflammatory cytokines, adhesion molecules, and enzymes. Polymorphonuclear leukocytes (PMNLs) play a central role in systemic inflammatory response after severe insult. The role of NF-kappa B in activation of PMNLs, however, has not been clear. We developed a simple flow cytometric method for quantifying expression of intranuclear NF-kappa B in PMNLs, and we used it to evaluate NF-kappa B activity in patients with systemic inflammatory response syndrome (SIRS). ⋯ Our new flow cytometric method proved useful for quantifying intranuclear NF-kappa B expression in PMNLs. In PMNLs from SIRS patients, intranuclear NF-kappa B expression and oxidative activity were significantly elevated with positive correlation, and enhanced expression of NF-kappa B may play an important role in PMNL activation in SIRS.