J Trauma
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Historically, the carrying of concealed firearms has been either substantially restricted or prohibited outright. Over the past two decades, laws making it easier for civilians to obtain permits allowing them to carry concealed weapons legally have proliferated throughout the United States. This study investigates the effect of such changes in state laws on state homicide rates. ⋯ The current findings are consistent with those of other published studies indicating that nondiscretionary concealed weapon laws are not associated with significant increases or decreases in homicide.
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Comparative Study
Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation.
Few data exist supporting a survival benefit to prehospital endotracheal intubation (ETI) over bag-valve-mask ventilation (BVM) in trauma patients. ⋯ In our trauma system, when corrected for mechanism and severity of anatomic and physiologic injury, ETI confers no survival advantage over BVM and slightly increases prehospital time.
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Comparative Study
Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities.
The radiologic study of choice for evaluation of traumatic arterial injuries is conventional arteriography, but it poses the risks of an invasive procedure. Computed tomographic arteriography (CTA) is emerging as a new way to study arterial anatomy, with the additional advantages of being noninvasive and a technique that allows evaluation of different body areas simultaneously. Our experience using CTA for evaluation of traumatic arterial injuries is provided in this study. ⋯ CTA is a reliable technique for the detection and characterization of traumatic extremity arterial injuries. These results suggest CTA may be an alternative to conventional arteriography for the diagnosis of traumatic arterial injuries.
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Comparative Study
Management of blunt thoracic aortic injuries: endovascular stents versus open repair.
Endovascular stent graft (EV) technology has been successfully adapted to the repair of blunt traumatic aortic injuries. The purpose of this study was to compare the outcomes of patients treated with EV repair and open repair after blunt thoracic aortic trauma. ⋯ We observed a clear trend toward improved outcomes after EV repair of thoracic aortic injuries compared with standard open repair. EV repair is emerging as the preferred method of repairing blunt thoracic aortic injuries in trauma patients with multiple injuries.
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Cerebral hypoxia (cerebral cortical oxygenation [Pbro2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing Pbro2 in patients with traumatic brain injury (TBI). ⋯ Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.