J Trauma
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Multicenter Study Comparative Study
Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy.
This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. ⋯ Patients whose first SI was ≥ 0.8 and second SI ≥ 1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI < 0.8 and base deficits ≥ -1.0 will not be candidates for the B group.
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Multicenter Study Comparative Study
Emergency medical services transport decisions in posttraumatic circulatory arrest: are national practices congruent?
To catalog the 9-1-1 emergency medical services (EMS) transport practices for posttraumatic circulatory arrest patients (PTCAPs) in the majority of the nation's largest municipalities and to compare those practices to guidelines recommended by the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACSCOT). ⋯ Many of the nation's highest volume EMS systems transport certain PTCAPs emergently, contrary to NAEMSP-ACSCOT guidelines to terminate resuscitative efforts in such cases. Reasons for these discrepancies should be evaluated to help better delineate applicable consensus guidelines for large urban EMS agencies.
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Multicenter Study Comparative Study
Compliance with a sepsis bundle and its effect on intensive care unit mortality in surgical septic shock patients.
The Surviving Sepsis Campaign was launched in 2002, aiming at a 25% reduction in mortality in sepsis during a 5-year period. We hypothesized that the compliance with an adapted sepsis bundle would improve intensive care unit (ICU) survival in a cohort of surgical septic shock patients. ⋯ In surgical septic shock patients, the outcome was significantly related to the number of fulfilled therapeutic guidelines included in a sepsis bundle.
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Multicenter Study Comparative Study
Variable application and misapplication of cricoid pressure.
In 1961, Sellick described a three-finger technique of cricoid pressure used to prevent gastric regurgitation during induction of anesthesia. The "Sellick maneuver" is now used worldwide. The authors have observed great variability in the application of cricoid pressure by health care providers and have suspected that misapplication occurs. The objectives of this observational study were to determine how many different techniques of cricoid pressure were being used and to identify the reasons for such variability of technique. ⋯ This observational study demonstrates that there is great variability in the application of cricoid pressure, identifying 10 different techniques in 32 observations. Misapplication does occur with possible patient harm. We suggest four possible reasons for this variability of technique. The authors use the three-finger cricoid pressure technique as originally described by Sellick and thought that this technique is effective, easy to teach, and safely keeps the fingers in the midline of the cricoid cartilage.