J Trauma
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Patients with spinal cord injury (SCI) are at particular risk for deep vein thrombosis (DVT) during their hospital course. In most researches on the prevention of thromboembolic events after SCI, the cause of SCI was usually limited to traumatic origin, and pharmaco-prophylaxis was usually started immediately after SCI irrespective of the presence of DVT. For this reason, it is difficult to determine the exact incidence of DVT after SCI from all possible causes in the absence of anticoagulation treatment. We sought to determine the incidence of DVT and the effect of mechanical treatments without chemical prophylaxis. ⋯ The incidence of DVT in patients with SCI routinely given mechanical prophylaxis without anticoagulation was higher when compared with those reported in the setting of routine pharmaco-prophylaxis. Anticoagulation should not be excluded from initial DVT prophylaxis measures in the SCI patients unless there is any ongoing bleeding or severe coagulopathy. Further studies will be necessary to get a more precise data and to understand the clinical relevance of these results.
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Endothelial nitric oxide synthase (eNOS) -786T→C and 894G→T polymorphisms have been associated with eNOS dysfunction, which might further compromise microcirculatory blood flow during sepsis and increase the risk of organ injury. The purpose of this study is to investigate the association of those two eNOS gene polymorphisms with the severity of organ dysfunction and outcome in patients with severe sepsis. ⋯ Carriage of the GT genotype at 894 of eNOS gene was associated with the occurrence of shock and impaired organ function.
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This study summarizes orthopedic injuries sustained in motorcycle collisions in patients presenting to a Level I trauma center. ⋯ Motorcycle collisions frequently involve patients in their working prime, thus placing substantial burden on the individual and society. Although these patients must continue to receive Level I trauma care, strengthened prevention and improved education efforts are warranted.
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The validity of current guidelines regarding resuscitation of patients in traumatic cardiopulmonary arrest (TCPA) and the ability of emergency medical services (EMS) to appropriately apply them have been called into question. The purpose of this study is to demonstrate the consequences of violating the current published guidelines and whether EMS personnel were able to accurately identify patients in TCPA. ⋯ Our data support the current guidelines regarding the withholding or termination of resuscitation of patients in prehospital TCPA and represent the largest series to date on this topic. EMS personnel were able to accurately determine traumatic cardiac arrest in the field in this series. Violation of the current guidelines resulted in six patients being resuscitated to a neurologically devastated state. No loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained.
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Plate osteosynthesis of the scaphoid, as reported earlier by Ender, has lost its importance in the past few years, after Herbert's introduction of the simple and successful technique of screw osteosynthesis. Only in rare cases does one encounter failed healing or instability of the fragments. Even with a vascularized bone chip, it is not always possible to achieve consolidation. Particularly in these situations, poor interfragmentary stability seems to be the reason for failed healing. ⋯ Scaphoid plate osteosynthesis should be regarded as a salvage procedure, and the indication for the procedure should be established accordingly. It is a simple procedure in terms of technique. The plate can be adjusted very well to the anatomic shape of the scaphoid, and one can achieve a high degree of stability, particularly rotational stability.