J Trauma
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During the past 5 1/2 years, 86 patients were treated for pulmonary contusion resulting from blunt trauma. Injury mechanism was motor vehicle in 65 patients (76%), farming in nine (10%), fall in eight (9%), and miscellaneous in four (5%). There were 68 males (79%) and 18 females. ⋯ Eighteen patients with concomitant flail chest demonstrated no increase in mortality but were likely to require mechanical ventilation (p less than 0.05). The extent of contusion assessed on admission chest roentgenogram was not predictive of mortality or need for intubation. We recommend aggressive treatment of associated injuries, craniocerebral trauma, and selective mechanical ventilation based upon degree of intrapulmonary shunt.
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The Committee on Trauma of the American College of Surgeons published a report in 1976 charging hospitals to provide care for seriously injured patients. Implementing an effective emergency care/trauma system in a not-for-profit community hospital was a task that demanded leadership, substantial time, and commitment. The building process could not have begun without a strong commitment from the hospital's board, administration, medical staff, and nursing service. ⋯ Monthly in-service programs were begun for the intensive care unit (ICU) and ED nurses. In each of the past 3 years, a 2-day trauma update program has been provided to the regional Emergency Medical Services (EMS) and medical community. The dedication and commitment of many people during the past 5 years has resulted in a sound system of emergency/trauma care in a community hospital.
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Any compromise of the reticuloendothelial system (RES) or host defense in general would militate against the potential benefit of fluorocarbon emulsions as oxygen-carrying resuscitation fluids. The relationship between lethal hemorrhagic shock resuscitation with Fluosol-DA 20% and subsequent host depression was examined in a rat model. Host tolerance to a standard intra-abdominal polymicrobial septic challenge was assessed 5 days after hemorrhagic shock. ⋯ In response to a septic challenge, survival of animals resuscitated with Ringer's lactate was similar to the control group, and fluorocarbon-treated animals had a significantly lower survival. It appears in this study that supplemental oxygen is not needed and that fluorocarbon emulsions act as a volume expander only. The enhanced mortality to a septic challenge may indicate a compromise in the host defense system induced by fluorocarbons, and clinical trials should proceed with caution accordingly.
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The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. ⋯ Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.
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Physical examination is often unreliable in the evaluation of blunt abdominal trauma. The utility of computed tomography (CT) in the early management of abdominal trauma in the absence of definite signs is controversial. CT was prospectively evaluated as an adjunct to physical examination in the initial assessment of blunt abdominal trauma. ⋯ Patients with acute pancreatic injuries may have normal CT findings. Eighty-six per cent of laparotomies were therapeutic. In conjunction with close clinical monitoring, CT was reliable in evaluation of blunt abdominal trauma in a selected group of patients.