J Trauma
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Nonoperative management of blunt splenic injury (BSI) has become the standard of care for hemodynamically stable patients. Successful nonoperative management raises two related questions: (1) what is the time course for splenic healing and (2) when may patients safely return to usual activities? There is little evidence to guide surgeon recommendations regarding return to full activities. Our hypothesis was that time to healing is related to severity of BSI. ⋯ Although mild BSIs heal faster than severe BSIs, nearly 10% of all the BSIs followed as outpatients worsened. Close observation of patients with BSI should continue until healing can be confirmed.
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Comparative Study
Femoral shortening after surgical treatment of trochanteric fractures in nongeriatric patients.
Femoral shortening is a well-known clinical finding after surgical treatment of per- and intertrochanteric fractures. Particularly, in geriatric patients with poor bone quality and unstable fracture types, secondary compression of these fractures often leads to length inequality of the lower limbs. In younger patients with good bone quality and mobilization with delayed weight bearing, limb length shortening is expected to be a rare complication. The purpose of this study was to analyze incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment. ⋯ Femoral shortening after operative treatment of per- and intertrochanteric fractures was found to be a common clinical finding in nongeriatric patients. Nearly half of them showed a lower limb length inequality after fracture fixation. The degree of the shortening was rather low and depended mainly on the fracture type. Comparing the two different implants used for operative treatment, a cephalomedullary nail was more successful in preventing limb length discrepancy in unstable fracture types than dynamic hip screw.
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Effective resuscitation is critical in reducing mortality and morbidity rates of patients with acute burns. To this end, guidelines and formulas have been developed to define infusion rates and volume requirements during the first 48 hours postburn. Even with these standardized resuscitation guidelines, however, over- and under-resuscitation are not uncommon. ⋯ Because the system can self-adjust based on monitoring inputs, the technology can be pushed to environments such as combat zones where burn resuscitation expertise is limited. A closed-loop system can also assist in the management of mass casualties, another scenario in which medical expertise is often in short supply. This article reviews the record of fluid balance of contemporary burn resuscitation and approaches, as well as the engineering efforts, animal studies, and algorithm development of our most recent autonomous systems for burn resuscitation.
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Comparative Study
Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma.
A number of large series' have attempted to examine the management of blunt solid organ injuries; however, only a few studies regarding multiple injuries exist. The aim of this study is to analyze whether multiple solid organ injury affects nonoperative management (NOM) and to look for predictive factors of NOM. ⋯ Lactate levels at admission, solid viscus score, necessity of transfusion, crystalloid resuscitation, and a drop in the hematocrit in the first hour after admission are useful parameters for judging the failure of NOM. Although there is a higher failure rate of NOM in multiple solid organ injury, NOM can still be considered in these cases with extra caution.
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Closed-loop algorithms and resuscitation systems are being developed to control IV infusion rate during early resuscitation of hypovolemia. Although several different physiologic variables have been suggested as an endpoint to guide fluid therapy, blood pressure remains the most used variable for the initial assessment of hemorrhagic shock and the treatment response to volume loading. Closed-loop algorithms use a controller function to alter infusion rate inversely to blood pressure. ⋯ Proportional-integral and fuzzy logic algorithms reduced mean fluid volume requirements compared with the nonlinear decision table; and (4) several algorithms have been constructed to the specific mechanism of injury and the volume expansion properties of different fluids. Closed-loop systems are undergoing translation from animal to patient studies. Future smart resuscitation systems will benefit from new noninvasive technologies for monitoring blood pressure and the development of computer controlled high flow intravenous pumps.