J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Tube thoracostomy and trauma--antibiotics or not?
Controversy persists regarding the use of antibiotics in association with t tube thoracostomy for trauma patients. We conducted a prospective randomized study of patients requiring tube thoracostomy for pneumo- and/or hemothorax complicating blunt or penetrating thoracic trauma in an attempt to assess the efficacy of prophylactic antibiotic therapy. Fifty-eight patients were included in the study. ⋯ Cultures demonstrated significant conversion from negative to positive both within each group and between groups. The organism most commonly recovered was S. aureus. Our findings strongly suggest that patients requiring tube thoracostomy for trauma, whether blunt or penetrating, should receive the benefit of systemic prophylactic antibiotic therapy.
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To describe the epidemiology of hospitalized, work-related burns among Massachusetts residents aged 16 years or older, 825 Massachusetts residents who were burned between 1 July 1978 and 30 June 1979, and who were treated as hospital inpatients in any of 240 New England hospitals, were studied. Two hundred forty (29%) of the 825 identified burns were known to be work-related. ⋯ Young workers and black workers experienced the highest rates of burning, with rates two and four times higher than their older and white counterparts, respectively. Scalds were the most common type of work-related burn injury for individuals in each age category, accounting for 45% of the burns overall.
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This prospective study evaluated the use of basic vital signs, two mechanisms of injury, and time-distance factors as field triage criteria for on-scene helicopter transport of 130 patients to a trauma center serving a rural area. The vital signs criteria included any one or more of the following: level of consciousness (LOC) less than or equal to unresponsive to verbal stimulation; respiration rate (RR) less than or equal to 10 or greater than or equal to 30; systolic blood pressure (BP) less than or equal to 90; pulse (P) less than or equal to 60 or greater than or equal to 120. The flight crew recorded vital signs taken by the first responder capable of basic assessment. ⋯ The presence of one or more abnormal signs identified a group of seriously injured trauma patients (mean Injury Severity Score = 29.1) with 24% mortality compared to a predicted mortality of 32% (p less than 0.02). Unresponsiveness to verbal stimulation in the field was the single most predictive criterion, yielding sensitivity of 93% and specificity of 85%. Time-distance criteria were helpful to determine helicopter use.
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Twenty-six individuals with second- and third-degree burn wounds have been grafted with cultured allogeneic epidermal cells. These epidermal cell grafts were grown in culture from cadaver skin according to a technique which we have developed. After being grafted with cultured allogeneic epidermal cells, superficial wounds, e.g., donor sites, healed within 7 days, compared to 14 days for mirror image control sites. ⋯ The cultured cells produced rapid healing in 11 of the 12 patients with deep second-degree burn wounds. The deep second-degree wounds grafted with cultured allogeneic epidermal cells healed with results which were comparable to the deep second-degree wounds which were autografted. Grafts of cultured allogeneic epidermal cells placed on full-thickness, or third-degree burn, wounds did not grow well.
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A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. ⋯ Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.