J Trauma
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A transthoracic focused rapid echocardiographic evaluation (FREE) was developed to answer specific questions about treatment direction regarding the use of fluid versus ionotropes in trauma patients. Our objective was to evaluate the clinical utility of the information obtained by this diagnostic test. ⋯ IVC diameter and IVC respiratory variation was able to be obtained in the majority of cases, giving an estimate of fluid status. Estimation of ejection fraction was useful in guiding the treatment plan regarding the requirement of fluid boluses versus ionotropic support. We conclude that the FREE can provide meaningful data in difficult to image critically ill trauma patients.
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The objective of this study is to report a temporary, ex vivo, distal extremity revascularization technique providing distal perfusion and allowing for a staged repair of complex iliofemoral injury. In addition, the objective of this report is to provide outcome data after this novel procedure including mortality, limb salvage, and quality of limb assessment. ⋯ Temporary ex vivo revascularization of the posterior tibial artery is a feasible option in selecting patients with blunt iliofemoral artery injury with ischemia and severe physiologic derangements. This unconventional method provides extremity perfusion distal to the injury and maintains neuromuscular viability during an interval period, allowing for a staged, proximal revascularization after improvement in the patient's physiologic condition.
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The Centers for Disease Control recently updated the National Trauma Triage Protocol. This field triage algorithm guides emergency medical service providers through four decision steps (physiologic [PHY], anatomic [ANA], mechanism, and special considerations) to identify patients who would benefit from trauma center care. The study objective was to analyze whether trauma center need (TCN) was accurately predicted solely by the PHY and ANA criteria using national data. ⋯ Current PHY and ANA criteria are highly specific for TCN but result in a high degree of undertriage when applied independently. This implies that additional factors such as mechanism of injury and the special considerations included in the Centers for Disease Control decision algorithm contribute significantly to the effectiveness of this field triage tool.
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The rates of nonunion after internal fixation for femoral neck fractures have been reported to range from 0% to 59%. Existing treatment options are osteotomy (with or without graft), osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula), or arthroplasty. The objective of this study was to assess the outcome results of revision internal fixation and nonvascular fibular bone grafting for symptomatic aseptic femoral neck nonunion. ⋯ This study showed that revision internal fixation and fibular autograft have resulted into a better and faster union rate than fibular allografts.
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Cervical extrication collars are applied to millions of blunt trauma victims despite the lack of any evidence that a collar can protect against secondary injuries to the cervical spine. Cadaver studies support that in the presence of a dissociative injury, substantial motion can occur within the occipitocervical spine with collar application or during patient transfers. Little is known about the biomechanics of cervical stabilization; hence, it is difficult to develop and test improved immobilization strategies. ⋯ Rigid cervical collars appear to create pivot points that shift the center of rotation lateral to the spine and contribute to the intervertebral motions that were measured. Immobilization strategies that avoid these neck pivot-shift phenomena may help to reduce secondary injuries to the cervical spine. The whole cadaver model with simulation of patient maneuvers may provide an effective test method for cervical immobilization.