J Trauma
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Catecholamine surge after traumatic brain injury (TBI) is associated with infectious morbidity and potentially preventable mortality. Previous studies have supported the protective effect of beta-adrenergic blockade in patients with TBI. We hypothesize that suppression of the catecholamine surge in multiple-injured TBI patients with beta-adrenergic blockade decreases mortality. ⋯ BB are associated with significantly reduced mortality in patients with TBI. This simple, inexpensive intervention may have a profound effect on mortality in this population of injured patients and requires further prospective study.
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A survey of all Canadian residents training in general surgery was conducted to determine the prevalence and nature of focused assessment with sonography in trauma (FAST) training. ⋯ The situation with FAST training in Canada seems inadequate with few general surgery residents being trained, and of those trained, only a few are comfortable with the technique. If FAST skills are to be expected of future surgeons, initiatives must be put in place to address barriers and improve training opportunities.
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Controlled Clinical Trial
Implementing and evaluating an injury prevention curriculum within a pediatric residency program.
Many pediatric residency programs struggle to incorporate injury prevention training into their curricula. ⋯ An injury prevention curriculum for pediatric residents can significantly increase and sustain their fund of knowledge on these important topics.
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Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients. ⋯ Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.
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Falls from height are considered to be high risk for multisystem injury. Ground-level falls (GLF) are often deemed a low-energy mechanism of injury (MOI) and not a recommended triage criterion for trauma team activation. We hypothesize that in elderly patients, a GLF may represent a high-risk group for injury and concurrent comorbidities that warrant trauma service evaluation and should be triaged appropriately. ⋯ Patients older than 70 years and with GCS score <15 represent a group with significant inhospital mortality.