J Trauma
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Comparative Study
Prospective evaluation of the sensitivity of physical examination in chest trauma.
Chest radiographs are routine for patients presenting with blunt and penetrating chest trauma. The accuracy of physical examination in the diagnosis of hemopneumothorax in these patients is unclear. A prospective study was performed to define the utility of routine portable chest radiographs in 676 trauma patients. ⋯ Blunt chest trauma patients who are hemodynamically stable with a normal physical examination do not require a routine chest radiograph. In contrast, all victims of penetrating trauma require chest radiographs because many will have hemopneumothorax in the absence of clinical findings.
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Comparative Study
An assessment of the potential for reducing future combat deaths through medical technologies and training.
We examined clinical records of combat casualties that died subsequent to reaching a medical treatment facility in an effort to determine whether new medical technologies or enhanced training might contribute to a reduction in combat deaths. ⋯ Surgeons reviewing records of past combat deaths indicated that reductions in the incidence of combat deaths through deployment of improved medical technologies and training is possible. Deployment of the noted technologies and proficiency in the cited training has the potential for reducing deaths by 8% to 25% when compared with the died-in-hospital incidence among casualties in the last sustained conflict.
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Comparative Study
Family impact greatest: predictors of quality of life and psychological adjustment in pediatric burn survivors.
Although there is some knowledge of psychological adjustment, almost nothing is known about quality of life in pediatric burn survivors. ⋯ If given optimal care, most pediatric burn survivors demonstrate excellent quality of life. Families with compromised relationships and patients with higher age at burn injury should be identified early, monitored closely, and offered psychosocial support as soon as dysfunctional family dynamics are detected.
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Comparative Study
Release of abdominal compartment syndrome improves survival in patients with burn injury.
Abdominal compartment syndrome (ACS) has rarely been described as a complication of burn injury. This study describes cases of ACS in patients with burn injury and the physiologic results of abdominal release. ⋯ Abdominal release for patients with ACS and severe burn injury results in physiologic improvement and a 40% survival rate. We recommend bladder pressure monitoring for all patients with severe burn injuries and abdominal decompression in any patient who develops pressures greater than 30 mm Hg if they have signs of physiologic compromise. Aggressive expectant management can effect a 40% survival rate in this group of severely injured patients.