J Trauma
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Catecholamine surge after traumatic brain injury (TBI) is associated with infectious morbidity and potentially preventable mortality. Previous studies have supported the protective effect of beta-adrenergic blockade in patients with TBI. We hypothesize that suppression of the catecholamine surge in multiple-injured TBI patients with beta-adrenergic blockade decreases mortality. ⋯ BB are associated with significantly reduced mortality in patients with TBI. This simple, inexpensive intervention may have a profound effect on mortality in this population of injured patients and requires further prospective study.
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Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients. ⋯ Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.
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Retrievable inferior vena cava filters (rIVCF) reduce the short-term risk of pulmonary embolism without the filter and inferior vena cava (IVC) thrombosis that have been reported with the use of permanent filters. Studies have shown that most rIVCFs are not removed, leaving patients at risk for thrombotic complications of rIVCF retention. We hypothesize that the application of a systematic follow-up for rIVCF will improve filter removal rates, providing patients short-term prophylaxis from pulmonary embolism whereas avoiding complications of permanent filter retention. ⋯ A dedicated system for following-up patients with rIVCFs markedly improves removal rates of retrievable filters.
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Victims of violence are likely to become repeat victims of violence. Emergency department-based secondary prevention initiatives have been proposed to help break the cycle of violence for these youth. Trauma centers, by nature of their designation, are often charged with the responsibility of developing these prevention initiatives. We hypothesize that the majority of youth who are injured by violence are treated in nontrauma centers. Given the goal is to prevent recurrent injury, trauma center-based initiatives may be misdirected. ⋯ Given the vast majority of patients are not seen at trauma centers, any prevention initiatives located here will not achieve the goals of preventing recurrent injury on a population basis. Secondary prevention initiatives should be implemented and evaluated in nontrauma centers.
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Civilian gunshot injuries to the head are relatively rare in the irenical European Union, and studies of treatment and outcomes are seldom for this region in the current literature. ⋯ Glasgow Coma Score at admission and the status of pupils and hemodynamic situation seem to be the most significant predictors of outcome in penetrating craniocerebral gunshot wounds. Computed tomography scans, bi- or multilobar injury, and intraventricular hemorrhage were correlated with poor outcome. Patients with a GCS score >8, normal pupil reaction, and single lobe of brain injury may benefit from early aggressive management.