J Trauma
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Case Reports
Severe hypoxemia revealing traumatic tricuspid regurgitation with right-to-left intracardiac shunt.
A case of traumatic tricuspid regurgitation immediately following chest trauma in an 18-year-old man is reported. The cardiac lesion was revealed by right-to-left shunt due to the reopening of the foramen ovale leading to hypoxemia exacerbated by controlled ventilation. Early surgical repair led to hypoxemia correction.
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From 1972 to 1982 there was a 23.9% decline in the number of deaths due to trauma in Nebraska. During this time, an improved emergency medical services (EMS) system was being implemented, including training of EMT's and paramedics, physician education in advanced trauma life support (ATLS), establishment of three helicopter transport services, and designation of trauma centers in the two most populous (of six) EMS regions. ⋯ We found that growth of the EMS system, as measured by the cumulative number of EMT's trained, correlated strongly with the decline in prehospital (r = 0.95; p less than 0.001), in-hospital (r = 0.84; p less than 0.001), total (r = 0.95; p less than 0.001), vehicular (r = 0.86; p less than 0.001), and nonvehicular (r = 0.93; p less than 0.001) trauma deaths. Our findings suggest that improvements in the statewide EMS system along with better hospital care have caused a significant decline in the number of trauma deaths over a 14-year period.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of methods of cervical immobilization used in patient extrication and transport.
We radiographically studied the efficacy of seven methods of cervical immobilization used in the prehospital setting. The methods were: Philadelphia collar, Hare extrication collar, rigid plastic collar, Philadelphia collar + short board, Hare extrication collar + short board, rigid plastic collar + short board, and the short board used alone. Ninety-seven normal volunteers were randomized to one of these seven methods and each volunteer served as his or her own control. ⋯ The short-board technique appeared to be superior to all the three collars studied. The collars provided no augmentation of immobilization over that provided by the short board alone. We believe that the short-board technique described herein, which is commonly used in the prehospital setting, can be used as the standard of comparison against which newer prehospital devices can be objectively compared.
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Randomized Controlled Trial Clinical Trial
Prophylactic antibiotics and no antibiotics compared in penetrating chest trauma.
Conflicting data exist concerning the value of antimicrobial prophylaxis in chest trauma. In a prospective and randomized study, we assessed the value of antibiotic prophylaxis in 80 consecutive relatively young, predominantly male patients admitted for gunshot or knife injuries of the chest. Forty patients received intravenous doxycycline and 40 received no antibiotic. Between the two groups we found no difference in the incidence of postoperative infections: we conclude that routine antibiotic prophylaxis is not recommended in penetrating chest trauma in patients such as ours.
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Blunt trauma to the chest and abdomen frequently results in cardiac injury. A wide spectrum of pathology can follow, including myocardial concussion and contusion, valvular disruption, and pericardial effusion and tamponade. ⋯ The various diagnostic studies utilized are frequently misinterpreted. The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.