J Trauma
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Venous thromboembolic events (VTE), such as deep vein thrombosis and pulmonary embolism, are major morbidities in adult trauma patients. Invasive and noninvasive prophylactic therapies are used to prevent VTE in trauma patients. The risk of VTE in pediatric patients is not well known. Is VTE prophylaxis necessary in the pediatric trauma population? ⋯ The risk of clinically significant thromboembolic event in trauma patients under age 13 is negligible. Therefore, VTE prophylaxis is unnecessary in pediatric patients with traumatic injury.
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The National Emergency X-Radiography Utilization Study defined five criteria for obtaining cervical spine radiographic investigations in blunt trauma patients. Distracting injury was given as the indication for more than 30% of all x-ray studies ordered. The hypothesis of this study was that upper and lower torso injuries would have different effects on clinical cervical spine assessment. ⋯ The National Emergency X-Radiography Utilization Study definition of a distracting injury may be narrowed. Upper torso injuries may be sufficiently painful to distract from a reliable cervical spine examination. Patients may detect spine tenderness in the presence of isolated painful lower torso injuries. Patients with spine tenderness warrant imaging.
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Detection of small (10-20%) increases in lung water may be relevant to detect incipient pulmonary edema but no clinically usable method has demonstrated this capability to date. ⋯ The transpulmonary thermodilution technique accurately detects small increases in extravascular lung water and may permit accurate diagnosis of incipient pulmonary edema.
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Trauma registries have been developed to describe the pattern of trauma and trauma workload, provide data for research, and to demonstrate changes in patient outcomes. Quality improvement using trauma registries at a system-wide level has been difficult to achieve. In Victoria, Australia, a statewide trauma system and trauma registry has been established to monitor and feedback the process of management and outcomes of major trauma patients across all healthcare providers. ⋯ VSTR data indicate that the statewide trauma system is working well and provides a method for ongoing monitoring and trauma care feedback.
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After emergency fasciotomy in acute compartment syndrome, skin graft techniques are usually necessary to cover the wound. ⋯ Gradual skin closure using the shoelace technique avoids the use of free skin grafts to close the dermotomy-fasciotomy wounds, reducing the need for anesthesia, nursing care, and hospital stays of patients, resulting in lower healthcare costs.