J Trauma
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Multicenter Study
Anemia and blood transfusion in trauma patients admitted to the intensive care unit.
Anemia is a common occurrence in the intensive care unit (ICU). Although resuscitation, including the use of blood, is a mainstay of early treatment of trauma victims, the safety and efficacy of red blood cell (RBC) transfusion has come under scrutiny recently. The issue of blood use in critically injured patients requires evaluation. ⋯ Anemia is common in critically injured trauma patients and persists throughout the duration of critical illness. These patients receive a large number of RBC transfusions during their ICU course with aged blood.
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The role of prehospital basic life support as opposed to prehospital advanced life support and the best qualifications for emergency personnel are controversial. Our objective was to establish whether the prehospital deployment of emergency physicians (EPs) rather than emergency medical technicians (EMTs) decreased mortality in blunt polytrauma patients. ⋯ In contrast with the deployment of EPs, care of blunt polytrauma patients by EMTs showed a statistical trend to a higher mortality than predicted and also a significantly higher risk of mortality. It is likely that the consistent deployment of EPs for moderate to severe blunt polytrauma in our catchment area might prevent between 0% and 23% of all deaths from blunt polytrauma or, in absolute terms, up to 1 death per year or 0 to 9.9 per 100 patients treated by an EP instead of an EMT.
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Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan?
The purpose of this study was to evaluate the roles of cervical spine radiographs (CSR) and computed tomography of the cervical spine (CTC) in the exclusion of cervical spine injury for adult blunt trauma patients. ⋯ No identifiable factors predicted false-negative CSR. There does not appear to be any role for CSR screening in this setting. The data from this study add to the growing body of evidence that CTC should replace CSR for the evaluation of the cervical spine in blunt trauma.
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A biomechanical cadaver study was performed to test the stability and strength of screw osteosynthesis of surgical neck fractures of the humerus. ⋯ Two of the smaller 4.5-mm cannulated screws should be applied parallel from the lateral direction. Only range-of-motion exercises that produce a bending stress should be considered early after surgery, avoiding axial stress.