J Trauma
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To compare differences in response times, scene times, and transport times by advanced life-support-trained paramedics to trauma incidents in urban and rural locations. ⋯ Response and transport times among professional, advanced life-support-trained paramedics responding to major trauma incidents are longer in rural areas, compared with urban areas.
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Comparative Study
Management of external penetrating injuries into the hypopharyngeal-cervical esophageal funnel.
To compare outcomes related to observation versus exploration for the hypopharynx and the cervical esophagus as the site of proven external penetrating injuries. ⋯ Overall, the consequences of an external penetrating injury become more serious in the descending levels of the funnel formed by the hypopharynx and cervical esophagus. Injuries located in the upper portion of the hypopharynx can be routinely managed without surgical intervention. Neck exploration and adequate drainage of the deep neck spaces are, however, mandatory for all penetrating injuries into the cervical esophagus and most injuries into the lower portion of the hypopharynx.
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Trauma has a high rate of recurrence, suggesting that some people are more injury-prone than others. This study was performed to evaluate some of the psychological and social factors that might influence the likelihood of traumatic injury. ⋯ Victims of trauma, both nonintentional, and especially intentional, have a high incidence of psychopathology. Victims of intentional trauma have significantly lower intelligence scores than either nonintentional injury or elective surgery patients. The high incidence of unemployment, alcohol abuse, and illicit drug use in victims of intentional injury might provide several opportunities for trauma prevention programs. Underlying psychological disorders will have to be addressed to reduce the likelihood of becoming a victim of trauma.
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Thrombelastography (TEG) is used to rapidly assess coagulation abnormalities in cardiac and transplant surgery. The purpose of this study was to investigate TEG in the initial assessment of trauma patient coagulation. ⋯ The majority of blunt trauma patients in this series were hypercoagulable. TEG is a rapid, simple test that can broadly determine coagulation abnormalities. TEG is an early predictor of transfusion in blunt injury patients.
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Comparative Study
Effects of increasing airway pressure and PEEP on the assessment of cardiac preload.
Cardiac preload is most commonly assessed by pulmonary artery wedge pressure. It was postulated that the right ventricular end-diastolic volume index (RVEDVI) derived by thermodilution would be a better predictor of preload in trauma patients with high airway pressures associated with positive pressure ventilation and positive end-expiratory pressure. ⋯ Unlike the pulmonary artery wedge pressure, RVEDVI is as reliable indicator of preload in the mechanically ventilated trauma patient. This is especially true when the right ventricular ejection fraction is not severely depressed.