J Trauma
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Comparative Study
Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank.
Pelvic fractures from blunt force trauma place the bladder and urethra at risk for injury, often resulting in significant complications. We sought to compare morbidity, mortality, and health care resource utilization in patients with and without genitourinary injuries (GUI) associated with pelvic fractures. ⋯ Patients sustaining a pelvic fracture with GUI have an increase in morbidity. Although GUI was not an independent predictor of mortality, patients who sustained a pelvic fracture with GUI had a greater number of concomitant injuries resulting in an increase in overall mortality compared with those without an associated GUI.
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The management of severe traumatic brain injury (sTBI) patients with and without intact cerebral pressure autoregulation (CPA) varies markedly. Recent studies, analyzing beat-to-beat interactions between intracranial pressure (ICP) and systolic blood pressure, or transcranial Doppler velocity changes during a rapid drop in cerebral perfusion pressure (CPP), suggest that CPA is disrupted after sTBI. We use computed tomography perfusion (CTP) to guide blood pressure manipulation in sTBI and have found CPA results that differ with this literature. We present these results here and suggest modifying our basic concepts of CPA disruption. ⋯ By using direct measurement of CBF in response to a CPP challenge, we found CPA disruption to be much less common than reported in similar groups of sTBI patients. This difference reflects potentially important separate aspects of CPA. We suggest that CPA measurement using beat-to-beat interactions and transcranial Doppler measurements reflect dynamic CPA processes (dynamic autoregulation), whereas our method reflects steady-state conditions (static autoregulation). If the major disruption of CPA after sTBI involves dynamic vascular responsiveness, perhaps we need more focus on this aspect and less on static-CPP manipulation in terms of pathophysiology and treatment.
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The pericardial window in a focused assessment with sonography for trauma (FAST) examination is highly accurate for detecting hemopericardium and, therefore, associated cardiac injury. A series of patients with false-negative pericardial ultrasound examinations, who were subsequently diagnosed with cardiac lacerations after presenting with stab wounds, are described. ⋯ The pericardial component of the FAST examination is commonly used for patients who present with penetrating wounds to the precordium. In cases of concurrent lacerations of the pericardial sac, pericardial ultrasound may not detect a cardiac injury because of associated decompression into the thoracic cavity.
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As the aging population continues to increase, the surgical needs of the elderly will increase. The acute care surgery model has been developed in which the trauma team also manages all general surgical emergencies to improve patient outcomes. We retrospectively reviewed our elderly acute care surgery population during the past 5 years to determine the variables affecting major abdominal surgery outcomes. ⋯ This is the first study to report mortality data and expected survival curves for major abdominal surgery in the octogenarian population. Our data prove that it is safer than previously thought to operate on the elderly. Our mortality data and survival curves provide real data for the surgeon to be able to risk stratify and discuss predicted outcomes with consultants, patients, and families.