J Trauma
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Changing methods of evaluating blunt abdominal trauma and expanding selection criteria for nonoperative management (NOM) of splenic injury can increase the number of patients managed nonoperatively without affecting success rates. ⋯ Use of computed tomography increased NOM of splenic trauma from 11 to 71% during the 5-year period for injuries of equivalent severity. Age > 55 years or abnormal neurologic status should not preclude NOM, because success was related only to injury grade.
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Clinical Trial Controlled Clinical Trial
The impact of antioxidant and splanchnic-directed therapy on persistent uncorrected gastric mucosal pH in the critically injured trauma patient.
Critically ill trauma patients with gastric intramucosal acidosis, as measured by gastric tonometry, have an increased incidence of multiple organ dysfunction syndrome despite supranormal O2 delivery. We altered our resuscitation protocol to maximize splanchnic blood flow and decrease oxygen-derived free radical damage. ⋯ Gastric tonometry-guided resuscitation and antioxidant/splanchnic therapy in critically ill trauma patients with persistent gastric mucosal acidosis may decrease multiple organ dysfunction syndrome.
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Insulin plus glucose, given for 7 days to hypermetabolic burn patients, has been shown to stimulate limb protein anabolism. We hypothesized that insulin plus glucose given to burn patients would also stimulate wound healing. ⋯ Data indicate that high doses of insulin and glucose can be safely administered to massively burned patients to improve wound matrix formation.
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Comparative Study
Trauma and thermal injury: comparison of hemostatic and cytokine changes in the acute phase of injury.
Initiated either by thermal injury or mechanical trauma, the systemic inflammatory response syndrome stimulates activation of coagulation and fibrinolysis, evolving into a subclinical disseminated intravascular coagulation. ⋯ There was a difference in the degree and level to which homeostasis was perturbed between the two groups. The mechanism of injury did not affect the initiation of subclinical disseminated intravascular coagulation and cytokine release, and the physiologic response remained the same.
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Comparative Study
Blunt chest impacts: assessing the relative risk of fatal cardiac injury from various baseballs.
To compare various soft-core baseballs for their ability to reduce the risk of fatal chest-impact injury. ⋯ The results of this study indicate that soft-core baseballs may not differ from a standard baseball with regard to the risk of fatal chest-impact injury while playing baseball. Other techniques, such as preventive coaching, need to be implemented when trying to improve baseball safety.