J Trauma
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We hypothesized that improvements in cellular immune function after hypertonic saline (HTS) resuscitation will alter the outcome of sepsis after hemorrhage. ⋯ HTS resuscitation leads to increased survival after hemorrhage and CLP. Marked improvements were observed in lung and liver injury compared with isotonic resuscitation. The better containment of the infection observed with HTS resuscitation corresponds to a marked decreased in bacteremia. HTS resuscitation stands as an alternative resuscitation regimen with immunomodulatory potential.
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Tissue oxygen tension can be measured directly in selected organ beds, and these measurements may be more sensitive in assessing the adequacy of resuscitation than global physiologic parameters. We hypothesized that heart tissue oxygen tension would be an important marker for the severity of ischemic insult to the heart during hemorrhagic shock. We further hypothesized that gut oxygen tension measured in the jejunum would prove to be a better measure of splanchnic hypoperfusion than intramucosal pH (pHi). ⋯ Tissue oxygen tensions measurements are highly responsive to changes induced during graded hemorrhagic shock and resuscitation. Gut PO2 and pHi appear to be measuring different physiologic processes in the gastrointestinal tract. The compensatory ability of the heart far exceeds that of the gut after ischemic insult. This hemorrhagic shock model appears feasible for the study of various methods of resuscitation.
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Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. ⋯ Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.
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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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Pedestrian injury accounts for approximately 14% of all vehicular-associated mortality. We performed a retrospective review of 1,014 injured pedestrians admitted to our statewide trauma center between January 1, 1990, and December 31, 1994, to determine the pattern and severity of pelvic injury in injured pedestrians, the types of associated injuries relative to those pelvic injury patterns, and the relationship between pelvic fracture treatment modalities and patient outcome. ⋯ In conclusion, pelvic fracture appears to be a substantial factor in pedestrian morbidity and mortality. Although most pedestrian morbidity and mortality is not caused by the intrinsic nature of the pelvic fracture, the severity of these injuries is correlated with the degree of destructive energy imparted to the body as a whole, as manifested by the number and severity of associated injuries and the mortality rate.