J Trauma
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Electrical injuries currently remain a world-wide problem. This study determines whether electrical injuries at our institution have changed in the past 30 years, and identifies electrical burn complications and any high-risk groups. ⋯ Although the incidence of low-voltage burns is currently on a steady decline, high-voltage injuries remain a problem, particularly in adolescent males.
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Case Reports
Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury.
We have reported a unique case of esophageal entrapment and obstruction from a thoracic spine hyperextension-dislocation injury after a motor vehicle crash. Because the risk for esophageal injury is not typically associated with thoracic spine injury, a heightened sensitivity for developing symptoms and signs is at least necessary. As with any injury to the gastrointestinal tract, optimal therapy requires resuscitation and prompt operative intervention.
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Trauma care delivery in Canada, even in major trauma centers, usually devolves to the most involved service. For patients with multisystem injuries, this is not always optimal and aspects of care outside the domain of the primary service are apt to be overlooked. Trauma care is necessarily multidisciplinary, and to be optimal, appropriate integration of the care process and prioritization are required. The purpose of this study was to examine the impact on care in a busy provincial trauma center, after the introduction of a trauma program with a clinical trauma service, revised trauma protocols, and a dedicated trauma unit. ⋯ Trauma care improvement can be achieved by a multidisciplinary team focusing on the process of care, developing a dedicated trauma service to manage the more seriously injured patients, collecting them onto a single unit, and initiating program management.
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The generation of iron-dependent toxic oxygen radicals during the initial resuscitation from hemorrhagic shock was shown to be a relevant factor for the initiation of the inflammatory cascade. Therefore, this experimental study was designed to evaluate the effects of a deferoxamine-conjugated hydroxyethyl-starch solution (HES-DFO) on oxygen radical induced injury and microcirculatory alterations in the rat liver compared with resuscitation with regular hydroxyethyl-starch, lactated Ringer's solution (RL), or a gelatin-based solution. ⋯ The results suggest that HES-DFO effectively reduces oxygen radical formation during the initial resuscitation period, thus, attenuating pathologically enhanced leukocyte adhesion and improving hepatic microcirculation.
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Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation. ⋯ We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.