J Trauma
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Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma. The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures. ⋯ Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy. They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.
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Comparative Study
Right ventricular volumes overestimate left ventricular preload in critically ill patients.
Studies have shown right ventricular end-diastolic volume (RVEDV) to be a more accurate estimate of left ventricular preload than pulmonary artery wedge pressure. We prospectively evaluated the ability of RVEDV to predict left ventricular end-diastolic volume (LVEDV) in critically ill patients. ⋯ RVEDV from the RF Swan markedly overestimated left ventricular preload. If RVEDV is used as an absolute value for determining preload, patients may be underresuscitated. Transesophageal echocardiography in conjunction with RF Swan can be used to more accurately determine preload and cardiac performance than RF Swan alone in critically ill patients.
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Comparative Study
Effect of small-volume resuscitation on intracranial pressure and related cerebral variables.
Head injury outcome is adversely affected by the presence of hypotension. Therapies directed at rapidly correcting hypotension may improve outcome. ⋯ Small-volume resuscitation with hypertonic saline and dextran and diaspirin cross-linked hemoglobin significantly improved mean arterial pressure and cerebral perfusion pressure compared with Ringer's lactate. These data suggest that small-volume resuscitation with hypertonic saline and dextran or diaspirin cross-linked hemoglobin may effectively limit or prevent secondary ischemic brain injury after head injury and shock.
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Resuscitation with hypertonic saline/dextran (HSD) has been suggested to be efficacious in patients who have traumatic brain injury and are hypotensive. We undertook a cohort analysis of individual patient data from previous prospective randomized double-blinded trials to evaluate improvements in survival at 24 hours and discharge after initial treatment with HSD in patients who had traumatic brain injury (head region Abbreviated Injury Score > or = 4) and hypotension (systolic blood pressure < or = 90 mm Hg). ⋯ Patients who have traumatic brain injuries in the presence of hypotension and receive HSD are about twice as likely to survive as those who receive standard of care.