J Trauma
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Nonoperative management of solid organ injuries caused by blunt abdominal trauma has been the standard care for many years. However, operative management is considered the standard care for penetrating abdominal trauma by most surgeons. The aim of this study was to assess the feasibility of selective nonoperative management of penetrating abdominal trauma in children. ⋯ The majority of abdominal stab wound and many gunshot wounds can initially be managed nonoperatively in children, when there is no hemodynamic instability or signs of hollow viscus perforation.
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Nail-gun accidents have become a common reason for penetrating ocular injuries in patients presenting to the emergency room with globe trauma. To date, there are only five patients (one case report and one small case series) in the medical literature of penetrating ocular injury due to nail-guns. The aim of this study is to describe the epidemiology and visual outcomes of patients presenting to a tertiary medical center with ocular injuries resulting from nail-gun injuries. ⋯ The majority of nail-gun injuries presented in this series were work-related. These injuries could be prevented with adherence to established safety measures including proper training and education of nail-gun operators, the use of sequential-trip triggers, and required safety glasses. Visual acuity outcomes of these 24 patients are better than what might be expected due to the nature of the injury.
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The objective of this study was to survey Trauma Center (TC) members of the National Foundation for Trauma Care/Trauma Center Association of America to determine usage and consistency of trauma team response charge codes and critical care accommodation charges for severely injured patients. Potential over- and underutilization of these enhanced reimbursements was assessed. ⋯ Significant underused opportunities exist for enhanced revenue by improved implementation of trauma response codes. Wide ranges in charges and the low frequency of full implementation suggest that education and coordination are needed among hospital departments involved, as well as among the trauma care community at large, to realize optimal reimbursement for trauma care services.
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Splanchnic perfusion is prone to early injury and persists despite normalization of global hemodynamic variables in sepsis. Volume replacement guided by oxygen derived variables has been recommended in the management of septic patients. Our hypothesis was that a hypertonic isoncotic solution would improve the benefits of crystalloids replacement guided by mixed venous oxygen saturation. ⋯ Although normalization of mixed venous oxygen saturation was not associated with restoration of markers of splanchnic or other systemic perfusion variables, the initial fluid savings with hypertonic saline and its latter effect on gut apoptosis may be of interest in sepsis management.