J Trauma
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This retrospective study of multiple trauma patients requiring SICU admission was undertaken to determine to what extent, if any, head injury affected patient outcome. One hundred seventy such patients with head injuries had further analysis. Glasgow Coma Scale (GCS) values at approximately 5 hours postinjury were evaluated, and the Glasgow Outcome Scale was determined 1 month postinjury. ⋯ This fell to 71% of the 24 patients with GCS 12-9. Among 59 patients having a GCS below 9, 41% died and an additional 17% had a poor recovery, leaving only 35% with an eventual good outcome. By using both Injury Severity Score and GCS at 6 hours postinjury, physicians will be more accurate in assessing outcome of multiple trauma patients with head injuries.
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Rapid fluid administration is the cornerstone of successful trauma resuscitation. Percutaneous insertion of catheter introducers has gained wide acceptance as a quick and reliable means of rapid intravascular volume expansion. Factors that affect rapid fluid resuscitation with these devices include catheter introducer kinking, the type and temperature of infusate, and diameter of co-apted administration tubing. ⋯ Piggybacking blood into an existing IV line instead of infusing it directly into the catheter can decrease blood flow 94% (340 cc/min vs. 20 cc/min). It is concluded that a large-bore catheter, by itself, does not guarantee high flow rates. Physician recognition of these concepts can result in improved resuscitation of hypovolemic patients.
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From 1975 to 1987, 19 patients (pts) were operated on for a traumatic lesion of the heart or of the ascending aorta. There were 15 males and four females with a mean age of 42 years. Twelve lesions (Group I) were penetrating and seven (Group II) blunt. ⋯ Intrapericardial lesions are relatively rare in our Canadian experience. High survival can be obtained in penetrating injuries, while blunt injuries are more complex and remain highly lethal. ECC should be available for definitive treatment.
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Three hundred sixty-seven consecutive pediatric trauma deaths which occurred in Ontario between 1985 and 1987 were analyzed from the coroners' records. Injuries were classified as survivable or unsurvivable, and a preventable death rate of 20% was identified. ⋯ The causes of death in children with survivable injury suggest that the institution of prehospital resuscitation and improvement in trauma care education for physicians might reduce mortality. The high incidence of unsurvivable injury suggests that injury prevention will be more cost effective in the long term.