J Trauma
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Given the contention that survival is to be expected from even the most severely burned child, then, intuitively, at least some pediatric burn victims die because of suboptimal care. The purpose of this study is to assess the impact of any adverse events that may have contributed to the death of burned children. ⋯ This review implies that deficiencies in health care contribute to the demise of many burned children. The most notable areas for improvement are in fluid resuscitation and airway control. This suggests that quality assurance and educational initiatives to improve these aspects of care may have the greatest impact on further improving survival of burned children.
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In Mexico and most other Latin American countries, many emergency medical services (EMS) systems rely on employees and volunteers with only on-the-job training and without formal Emergency Medical Technician (EMT) certification. This study sought to evaluate the costs and effectiveness of providing EMT certification to all personnel working in an EMS service in a Mexican city. ⋯ These data support the promotion of policies that require and enable EMT certification for all prehospital care providers in Mexico and potentially also in other Latin American and other middle-income developing countries.
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Comparative Study
Comparative efficacy of granular and bagged formulations of the hemostatic agent QuikClot.
QuikClot is a zeolite-based dressing approved and deployed by military for the arrest of severe combat-induced hemorrhage. A novel formulation (bagged QuikClot [ACS]) of the original granular QuikClot (QC) has been proposed to facilitate the application of the hemostatic dressings under battlefield conditions. This study compares the hemostatic efficacy of ACS and QC in controlling blood loss and improving survival in a swine model of uncontrolled hemorrhage induced by complex groin injury. ⋯ ACS was as efficacious as original granular QC in inducing hemostasis and improving survival as compared with the efficacy of SD. Easier and more rapid application and complete removal of ACS may offer a distinct advantage in battlefield resuscitation efforts to enhance a clean wound site and eventual surgical repair.
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Prior surveys of acute medical management of severe traumatic brain injury (TBI) indicate that care is fragmented and inconsistent, although Guidelines for the management of severe traumatic brain injury (guidelines) were distributed and endorsed by the American Association of Neurologic Surgeons. We conducted a survey of US trauma centers to evaluate guideline adherence, to examine predictors of adherence, and to compare our results with similar surveys conducted in 1991 and 2000. ⋯ Adherence to evidence-based guidelines for severe TBI has improved dramatically since 1991. Trauma center level and treatment protocols were associated with good adherence, suggesting that directing patients with severe TBI to Level I and Level II trauma centers with treatment protocols will improve outcome for these patients.
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Comparative Study
Ischemic preconditioning prevents skeletal muscle tissue injury, but not nerve lesion upon tourniquet-induced ischemia.
Prolonged ischemia followed by reperfusion (I/R) of skeletal muscle results in significant tissue injury. Ischemic preconditioning (IPC), achieved by brief periods of ischemia before sustained ischemia, has been shown to ameliorate I/R injury in a variety of tissues. We demonstrate that tourniquet hind limb ischemia-induced injury of the muscle benefits from IPC, whereas the peripheral nerve suffers from prolonged ischemia time and mechanical deterioration on IPC. ⋯ High susceptibility of the peripheral nerve to compression-induced ischemic injury disproves IPC in its clinical application for surgical procedures requiring prolonged tourniquet ischemia.