J Trauma
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Pulmonary gas exchange in correlation with condensed lung volume was prospectively studied in 10 patients with multiple injuries and blunt chest trauma. The purpose was to find nomograms that allow the estimation of the extent of pulmonary density from gas exchange parameters. The condensed lung volume was determined planimetrically from serial transverse sections of chest computed tomographic scans. ⋯ By using linear regression equations (linear regression line with 95% confidence interval), nomograms were calculated. The extent of pulmonary density can easily be obtained from these nomograms by measuring Qs/Qt or P(A-a)O2. The presented nomograms may be helpful in monitoring the effect of treatment in patients with blunt chest trauma.
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Cycle safety helmets are designed to prevent head injury. Although most commercially available helmets conform to one of several national and international standards, individual designs differ widely, particularly in relation to face coverage. A method was developed to assess the potential for the differing designs to protect the face from injury. ⋯ It was concluded that the dimensions of cycle helmets in relation to face coverage are crucial in influencing the extent to which facial protection is conferred. International test standards need urgent revision to ensure that face coverage is optimized. Lower-face protection could be achieved through incorporation of a lower-face bar to cycle helmets.
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To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries. ⋯ Scene flights in this metropolitan area for patients who suffered noncranial penetrating injuries demonstrated that these flights were not medically efficacious. This conclusion rests on the findings that arrival at a trauma center was not hastened by scene flights and that only 4.9% of patients required prehospital care by the medical flight crew beyond the capabilities of the first-responding EMS personnel (2.5 and 6.7% for ALS and BLS responders, respectively). Based on this experience, we believe that in metropolitan areas, scene flights for victims of noncranial penetrating injuries should be restricted to critically injured patients likely to require prehospital care by the medical flight crew that is beyond the capabilities of the first responders or when the scene flight is likely to significantly hasten the arrival of the injured patient to an appropriate trauma center.
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(1) To independently validate the Trauma and Injury Severity Score-Like (TRISS-Like) model derived by Offner et al. (Revision of TRISS for intubated patients. J Trauma. 1992;32:32-35) in a population of Canadian blunt trauma victims, and (2) to compare the ability of this model to predict mortality in early and late trauma deaths. ⋯ TRISS-Like demonstrated similar performance to that reported with the standard TRISS model but with the additional advantage that it is more generalizable because it can be applied to intubated patients. TRISS-Like demonstrated substantially superior performance in early trauma deaths compared with those that occurred late. This differential performance may be because the model does not include risk factors for late mortality.
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Management of deep dermal hand burns represents a difficult clinical problem for the burn team because bedside estimation of burn depth is unreliable. Early identification of full-thickness injury and prolonged healing times might result in the decision to perform surgical excision of eschar and skin grafting of the wounds. Such a strategy may improve overall functional and cosmetic results of hand burn treatment. ⋯ Laser Doppler flowmetry may serve as a valuable adjunct to the prediction of the need for grafting and time to wound closure. Standardization of flowmetry data and techniques of evaluation are desirable. Spontaneous healing should be the goal in the majority of deep dermal hand burns.