J Trauma
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A biomechanical cadaver study was performed to test the stability and strength of screw osteosynthesis of surgical neck fractures of the humerus. ⋯ Two of the smaller 4.5-mm cannulated screws should be applied parallel from the lateral direction. Only range-of-motion exercises that produce a bending stress should be considered early after surgery, avoiding axial stress.
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Hemostasis can be difficult to achieve after blunt abdominal trauma, especially if the patient is coagulopathic. The U.S. Food and Drug Administration has recently approved a hemostatic dressing for treating bleeding after extremity trauma (RDH bandage; Marine Polymer Technologies, Cambridge, MA). It has not been evaluated for internal bleeding after trauma. We redesigned this dressing for internal use, and then tested whether this modified bandage (Miami-modified Rapid Deployment Hemostat) could achieve hemostasis when used as an adjunct to standard laparotomy pad packing in a pig model of severe liver injury with coagulopathy. ⋯ The Miami-modified Rapid Deployment Hemostat bandage significantly reduced mortality, blood loss, and fluid requirements when used as an adjunct to standard abdominal packing following severe liver injury in coagulopathic pigs [corrected].
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BACKGROUND Identification of ventilator-associated pneumonia (VAP) with invasive methods such as bronchoalveolar lavage (BAL) paired with treatment is associated with improved mortality. Inappropriate antibiotic use, however, is known to increase bacterial resistance, making future treatment problematic. Thus, the diagnostic threshold for VAP in BAL must yield adequate sensitivity while limiting exposure of patients to unnecessary antibiotics. Our institution uses a cutoff of > or = 10(5) colony-forming units (CFUs)/mL, but the optimal cutoff remains an area of debate. In this project, the effects of lower diagnostic cutoffs on VAP diagnosis and unnecessary antibiotic use are examined. ⋯ A threshold of > or = 10(5) CFUs/mL for VAP diagnosis carries a low false-negative rate. Over 80% of additional patients who would have been treated had a threshold of > or = 10(4) CFUs/mL been used recovered without treatment and thus would have undergone unnecessary antibiotic exposure. A similar pattern is seen at all lower thresholds. Lower diagnostic thresholds would lead to marginal increase in sensitivity, and many would receive unnecessary VAP treatment with potential for increasing bacterial resistance.
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Lung protective ventilatory strategies using low tidal volume and high positive end-expiratory pressure (PEEP) have become standard practice. Such strategies, however, may invalidate measurement of lung injury severity by traditional methods that are based on plain chest radiograph findings, oxygenation, minute ventilation, lung compliance, and PEEP level, such as the Murray lung injury score (LIS). Many of these criteria are potentially therapy dependent and may change with different ventilatory strategies. The purpose of this study was to determine whether measurement of lung injury severity based simply on oxygenation criteria (PaO(2)/FIO(2)) was as accurate as the Murray LIS currently used in multiple organ failure (MOF) scoring. ⋯ The P/F score is a simple method of quantifying lung injury severity in trauma patients that better predicts mortality compared with the more complicated modified Murray lung injury score currently in use. The P/F score should replace more complex and potentially therapy-dependent scores.
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Little data are available regarding the impact that prolonged prophylactic antibiotic use (>48 hours) has on the development of nosocomial pneumonia. This retrospective study was conducted to assess the effect that prolonged prophylactic antibiotic use has on the development of nosocomial pneumonia and antibiotic use complications. ⋯ Justification for the use and duration of prolonged (>48 hours) prophylactic antibiotics requires careful reevaluation because this practice is associated with significant clinical complications that lead to increased use of patient resources, lengthened hospital stay, and higher cost.