J Trauma
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Controversy swirls about optimal control of life-threatening hemorrhage from an injured extremity whether in combat in the Middle East or in trauma care at home. Left unanswered are four critical questions: (1) What is the simplest tourniquet available? (2) Can it be used below the elbow and the knee? (3) Is pain a factor? (4) What data support so called "Pressure Points?" ⋯ Our data indicate that all tourniquets can be used successfully below the knee or elbow. The cloth and windlass is the easiest to apply. It is probably the most readily available or simplest to procure/improvise. Pain is irrelevant. "Pressure Point Control" of extremity arterial hemorrhage is a euphemistic misnomer.
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Optimizing patient outcomes has promoted a protocol-driven environment within the trauma bay. No standardized laboratory panel exists during the initial evaluation of injured children. ⋯ The implementation of a standard laboratory panel increased the uniformity of care without compromising quality. We limited the volume and initial cost of blood drawn which is advantageous in small children.
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To determine whether the prophylactic placement of an inferior vena cava (IVC) filter after acute spinal cord injury (SCI) causes an increased incidence of deep venous thrombosis (DVT). ⋯ The presence of prophylactic IVC filters in acute SCI patients may actually increase the risk of DVT, which has its own associated morbidities and costs.
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The objective of this study was to determine the optimal use of fresh-frozen plasma (FFP) in trauma. Our hypothesis was that a higher FFP: packed red blood cells (PRBC) ratio is associated with improved survival. ⋯ Higher FFP:PRBC ratio is an independent predictor of survival in massively transfused patients. Aggressive early use of FFP may improve outcome in massively transfused trauma patients.
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Miami-Dade County, FL, has one of the highest numbers of pediatric pedestrian injuries in the country. To respond to this problem, WalkSafe an elementary school-based pedestrian injury prevention program was created. The purpose of this study was to evaluate the effectiveness of the 3-day WalkSafe educational curriculum in a high-risk district. ⋯ The 3-day WalkSafe educational curriculum implemented in a high-risk district was shown to increase the pedestrian safety knowledge of elementary school age children. From recommendations made by teachers and multiple agencies, the modified 3-day program was approved to implement on a yearly basis in all public elementary schools in Miami-Dade County. Further studies will investigate the transfer of knowledge gain to behavioral change among elementary school-aged children.