J Trauma
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Recalcitrant coagulopathy "the bloody vicious cycle," produces the majority of deaths after torso trauma. A model predicting this life-threatening complication may facilitate clinical decision-making. ⋯ Postinjury life-threatening coagulopathy in the seriously injured requiring massive transfusion is predicted by persistent hypothermia and progressive metabolic acidosis.
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Improvement in trauma patient outcome has been demonstrated after the implementation of the Prehospital Trauma Life Support (PHTLS) program in Trinidad and Tobago. This study was aimed at identifying prehospital care factors that may explain this improvement. ⋯ Prehospital trauma care has changed after the introduction of the PHTLS program as indicated by more frequent airway control, use of oxygen, control of cervical (C)-spine and hemorrhage, as well as splinting of fractures. This finding was evident not only as a routine but particularly when a specific related problem was identified. This change in prehospital care could be responsible for the improved trauma patient outcome after PHTLS.
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Injury to the heart has been studied extensively. However, a small group of patients with injuries to the coronary arteries or intracardiac structures may require a different operative approach. ⋯ The mortality for complex injuries (coronary, septal, valvular) was 53%. This group was a specific population that self-selected by surviving to operation. Acute operations for complex injuries (beyond cardiorrhaphy) were primarily heroic life-saving efforts. Reoperation for cardiac injuries was most common for septal or valvular injuries. Only 2% of all survivors required reoperation to correct a residual defect.
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Recent reports have documented a reduced mortality from injuries to the inferior vena cava (IVC). Few reports, however, have addressed the follow-up of the repaired IVC. From January of 1984 to December of 1995, we prospectively collected data on all patients with IVC injuries at Lincoln Medical and Mental Health Center, an urban Level I trauma center. ⋯ We conclude that sonography and computed tomographic scan provide reliable noninvasive evaluation of the repaired IVC. We recommend that all patients with an IVC injury, which has been repaired, undergo evaluation for patency before discharge.
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Fetal mortality after trauma is significant. This study was aimed at identifying factors responsible for this high fetal mortality. ⋯ Apart from ISS, blood loss, and abruptio placentae; the presence of DIC was the most significant predictor of fetal mortality. This finding may represent stimulation of DIC by placental products entering the maternal circulation after significant intrauterine injury.