J Trauma
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Comparative Study
Methicillin-resistant Staphylococcus aureus in wound cultures recovered from a combat support hospital in Iraq.
Staphylococcus aureus infections complicate care of combat-related injuries and can independently result in skin and soft-tissue infections during deployments or training. Community-associated methicillin-resistant S. aureus (CA-MRSA) strains seem to produce severe disease but retain susceptibility to many oral antimicrobials. This study characterizes 84 MRSA isolates recovered from wound cultures at a combat support hospital in Iraq. ⋯ This study is the first genotypic and phenotypic characterization of CA-MRSA recovered from wound cultures in a deployed combat hospital. The pattern noted was similar to that seen in soldiers stationed in the United States.
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The purpose of this article is to describe the clinical course and outcome of drowning cases related to current US military combat operations. ⋯ Drowning associated with combat operations was associated with severe acute respiratory distress syndrome and cardiovascular shock. GCS score and the need for CPR at the scene of injury were associated with eventual mortality because of anoxic brain injury in all cases.
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Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. ⋯ Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.
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The cost of trauma center care is high, raising questions about the value of a regionalized approach to trauma care. To address these concerns, we estimate 1-year and lifetime treatment costs and measure the cost-effectiveness of treatment at a Level I trauma center (TC) compared with a nontrauma center hospital (NTC). ⋯ Our findings provide evidence that regionalization of trauma care is not only effective but also it is cost-effective.
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Abdominal compartment syndrome and intra-abdominal hypertension cause morbidity and mortality. Body mass index (BMI) may affect intra-abdominal pressure (IAP). Knowledge of the baseline IAP in the obese and the effect of BMI are not clearly defined. ⋯ Baseline IAP in the obese is greater than normal weight population (0-6 mm Hg), but not in range of intra-abdominal hypertension (>12 mm Hg). Postoperative status is unrelated to IAP. Elevated BMI does impact IAP, but the incremental value is small. Markedly increased IAP should not be attributed solely to elevated BMI and should be recognized as a pathologic condition.