J Trauma
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The literature on early management of gunshot wounds (GSWs) to the face is scant, with only six series reported in the English-language literature in the last 12 years. In the current study, we present a large series from a busy trauma center in an effort to identify early diagnostic and therapeutic problems and recommend management guidelines. ⋯ Most civilian GSWs can safely be managed nonoperatively. Airway control is required in a significant number of patients and should be established very early. Bleeding from the face is best controlled angiographically. The brain and cervical spine should be aggressively assessed radiologically because of the high incidence of associated trauma.
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Scepticism has been expressed regarding the accuracy of computed tomography for evaluating patients with blunt abdominal trauma in low-volume institutions. Diagnostic peritoneal lavage has been suggested as a more reliable method, and recently ultrasound has been proposed as a quick alternative. We sought to determine the accuracy of computed tomography at our low-volume center, which lacks 24-hour, in-house computed tomography dedicated radiologists. ⋯ The accuracy of computed tomography for evaluating blunt abdominal trauma at a low-volume institution is comparable to that reported from higher-volume centers and may be the procedure of choice, averting the expected higher incidence of nontherapeutic laparotomy attendant with more widespread application of diagnostic peritoneal lavage and the missed injuries that may be expected from the occasional ultrasonographer.
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To analyze the parameters measured in the field, during transport, and upon arrival of the physiologic condition of patients sustaining penetrating cardiac injuries, along with the Cardiovascular Respiratory Score (CVRS) component of the Trauma Score, the mechanism and anatomical site of injury, operative characteristics, and cardiac rhythm as predictors of outcome. We also set out to identify a set of patient characteristics that best predict mortality outcome and to correlate cardiac injury grade as determined by the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) with mortality. ⋯ Parameters measuring physiologic condition, CVRS, and mechanism of injury are significant predictors of outcome in penetrating cardiac injuries. AAST-OIS injury grades I-III are rare in penetrating cardiac trauma. AAST-OIS Injury grades IV-VI are common in penetrating cardiac trauma and accurately predict outcome.
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This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours. ⋯ Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.
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To examine the occurrence of hypotensive episodes in patients with severe traumatic brain injuries that are not of hypovolemic origin and to investigate possible neurogenic or iatrogenic causes of such episodes. ⋯ (1) Some episodes of severe traumatic brain injury-related hypotension may be of neurogenic origin. (2) The risk/benefit ratio of early diuretic use in patients with severe traumatic brain injuries may be too high to support liberal use. These data strongly support the need for a study involving prospective collection of data describing the early blood pressure courses in such patients.