J Trauma
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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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Twenty-one children admitted between December 1981 and May 1985, with greater than 80% total body surface area burn (TBSAB), underwent total excision and grafting of all of their wounds within 72 hours of injury. Twelve survivors (with an average TBSAB of 89%, 82% third degree) were studied in detail describing the length of hospital stay (77 +/- 10 days), number of operative procedures (7.8 +/- 0.8), total blood loss (12 +/- 2 blood volumes), the number of patients who experienced septic episodes (three), the number of patients who required amputation (four), range of motion, degree of scarring, ability to perform daily activities, and psychological adjustment. ⋯ One third of the children had excessive fear, regression, and neurotic and somatic complaints, but all of them showed remarkable energy in adapting to their disabilities. We conclude that the final outcome, for these patients, can only be assessed as they achieve late adolescence and young adulthood.
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Randomized Controlled Trial Clinical Trial
The effects of inflation of antishock trousers on hemodynamics in normovolemic subjects.
Antishock trousers may maintain mean arterial pressure in trauma patients by increasing central blood volume and cardiac output. Hemodynamics, end-diastolic volume, stroke volume, cardiac output, and blood pressure were recorded in eight supine, healthy men in antishock trousers using two-dimensional echocardiography. Two inflation protocols were used. ⋯ The study shows that the antishock trousers alter several hemodynamic parameters. With lower inflation pressures, antishock trousers cause an increase in arterial pressure by increasing peripheral resistance. At higher inflation pressures, the antishock trousers increase cardiac output and as the cardiovascular system adjusts, maintain the pressure by increasing peripheral resistance.
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A 5-year experience with 12 sternal fractures treated at the Los Angeles County Harbor/UCLA Medical Center is presented. Our data indicate that sternal fractures with roentgenographic mediastinal widening commonly have associated aortic injuries. There is an almost uniform depression of right ventricular or anterior left ventricular function associated with sternal fractures and these cardiac sequelae are documentable by first-pass biventricular radionuclide angiography including left ventricular segmental wall motion analysis. ⋯ In contrast, the incidence of displaced or unstable fractures is very low. Only one patient in this series had a depressed manubriosternal fracture, and no injury necessitated surgical stabilization. The outcome of isolated sternal fractures is benign, and they should be viewed as harbingers of the discovery of other injuries.
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Serum creatine kinase isoenzyme (CK-MB) screening followed by two-dimensional echocardiography (2-DE) was used for the assessment of possible cardiac injury in victims of blunt trauma with acute thoracic or rapid deceleration injury. Of 291 victims evaluated acutely, 58 (20%) had a CK-MB fraction evident within 24 hours after injury. ⋯ Distinction between concussion and contusion has enabled development of a rational acute management protocol. A total of 70 patients with documented blunt cardiac injury (58 evaluated acutely, nine dead on arrival or died in the emergency room, and three delayed presentations) seen at this institution over 4 years are reported, illustrating the full spectrum of blunt cardiac injury.