J Trauma
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Case Reports
Contralateral acute subdural hematoma after surgical evacuation of acute subdural hematoma.
We present a case of an 81-year-old woman who developed an acute left-sided subdural hematoma with midline shift shortly after craniotomy for evacuation of a traumatic right-sided acute subdural hematoma. She was immediately taken back to the operating room for evacuation of the left-sided clot and her neurologic outcome was excellent. Believed to be caused by rapid brain decompression, bleeding far from the operative site, such as a within the contralateral subdural space, can occur after a craniotomy and must be promptly recognized.
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A prospective, longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed. ⋯ There was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts. The 22.1% KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices. The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6% with the use of individual body armor.
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Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive trauma care. We hypothesized that penetrating trauma patients who are spine immobilized before transport have higher mortality than nonimmobilized patients. ⋯ Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma.
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To assess clinical and functional outcomes as well as the relative stability of various configurations of tension band wiring approaches for treating olecranon fractures, a retrospective cohort study was conducted. ⋯ Placement of the ends of Kirschner wires in the proximal ulnar canal should be avoided whenever possible. Because placement of the ends of Kirschner wires through the anterior ulnar cortex may produce serious complications as reported in medical literature, placement of the ends of Kirschner wires in the distal ulnar canal may be the most effective approach.
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Rapid trauma evaluation and intervention without time delay are considered integral to time-efficient management of trauma patients, particularly for those with hemodynamic instability. This study examined the impact of immediate availability of mobile angiography with digital subtraction angiography technology in the emergency department (ED) for hemodynamically unstable multiple trauma patients with pelvic injury. ⋯ Immediate availability of mobile angiography in the ED seems safe and effective for hemodynamically unstable trauma patients with pelvic injury and results in a rapid improvement in resuscitation intervals without leaving the ED. An adequately randomized controlled trial of mobile angiography in this subset of patients, who would seem to derive the most benefit from mobile angiography, would be ideal.