J Trauma
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Comparative Study
Diaspirin cross-linked hemoglobin resuscitation improves cerebral perfusion after head injury and shock.
Shock associated with traumatic brain injury (TBI) doubles the mortality of TBI alone by inducing a secondary ischemic injury. Rapid correction of cerebral perfusion pressure (CPP) is thought to be essential to improving outcome. Diaspirin cross-linked hemoglobin (DCLHb) has been shown to improve cerebral blood flow, increase mean arterial pressure (MAP), and reduce lesion size in models of occlusive cerebral ischemia but has not been evaluated in a model of TBI combined with hemorrhagic shock. ⋯ These data suggest that DCLHb is beneficial in the early resuscitation of head injury and shock and that further investigation is warranted. Key Words: Diaspirin cross-linked hemoglobin, Head injury, Shock, Cerebral perfusion pressure.
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The clinical features and successful management of a patient with right main bronchus disruption after blunt chest trauma are described. The presentation was one of bilateral tension pneumothoraces. A high index of suspicion, coupled with appropriate airway management at presentation, was vital for the successful treatment of this patient. Surgical resection using a sleeve lobectomy, an operation rarely used in trauma patients, was highly effective in this patient, and the technique is described in this report.
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Inappropriate use of helicopter transport of trauma patients in urban areas increases costs, risk of injury, and unavailability for appropriate flights. We evaluated the effect of an emergency medical service (EMS) system audit of helicopter trauma scene flights (TSFs) on appropriateness of TSFs. ⋯ An EMS system audit with general awareness of audit criteria decreased the total number of TSFs and hence the number of INAPPRO TSFs in this urban trauma system population. However, the proportion of TSFs that were considered INAPPRO did not change. Criteria for urban TSFs should be based on markers of critical physiologic patient status matched to unique care that the helicopter personnel can provide (e.g., advanced airway management).
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We report on a case of blunt thoracic trauma that resulted in complete disruption of the right main bronchus. Due to massive loss of respiratory volume during thoracotomy, sufficient ventilation could not be maintained via the orotracheal tube. Transthoracic intubation of the left main bronchus via the right bronchial defect was the ultima ratio procedure that allowed reanastomosis of the disrupted right main bronchus.
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Trauma victims with hypotension require a rapid and reliable localization of bleeding and expedient surgical triage. Our hypothesis is that emergent abdominal sonography (EAS) is a rapid and accurate test of the need for urgent laparotomy in blunt trauma victims with hypotension. ⋯ EAS is a rapid and accurate indicator of the need for urgent laparotomy in the hypotensive blunt trauma victim. Further, a negative EAS can hasten the search for other causes of hypotension. Diagnostic peritoneal lavage may become obsolete in centers with EAS capabilities.