J Trauma
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Review Case Reports
Aortic dissection after trauma: case report and review of the literature.
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Trauma center resource management could be facilitated by a readily available indicator of resource consumption. This marker should identify patients more likely to require transfusion and intensive care services and to develop complications. Base deficit (BD) has been shown to be a valuable indicator of shock, abdominal injury, fluid requirements, efficacy of resuscitation, and to be predictive of mortality after trauma. This study was performed to determine whether BD could be used to identify which patients were likely to require blood transfusion in the first 24 hours of hospitalization, and to develop shock-related complications and increased intensive care unit (ICU) and hospital stays. ⋯ Admission BD identifies patients likely to require early transfusion and increased ICU and hospital stays, and be at increased risk for shock-related complications. Patients with BD < or = -6 should undergo type and cross-match rather than type and screen. The use of ISS and BD category probability curves may identify candidates for early invasive monitoring.
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Posttraumatic bacterial mediastinal abscess resulting from closed blunt trauma without penetrating injury or tracheal or esophageal rupture is, to our knowledge, previously unreported. We report a case of a patient injured in a motor vehicle collision that resulted in closed blunt chest trauma and mediastinal abscess 14 days after injury. Initial chest roentgenogram revealed a widened mediastinum. ⋯ The abscesses were drained and the sternomanubrial wound debrided in stages. The mediastinal defect was reconstructed with a pectoralis major muscle flap. This most likely represents bacterial seeding of the mediastinal hematoma from a distant source.
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To determine the nature and causes of gun violence among urban young people. ⋯ Handgun availability and use are high among urban youth; gun carrying is mostly related to safety concerns and easy access, rather than to hunting or sport. This may be a cause of high handgun injury rates in this group. Gun injury prevention programs must address youth safety concerns along with handgun availability.
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To review our experience with craniocerebral injuries caused by plastic bullets, and to delineate prognostic factors for outcome. ⋯ Plastic bullet-induced craniocerebral injuries carry a lower morbidity and mortality rate compared with other gunshot wounds. However, plastic bullets do incur a significant risk of injury. Their use should be carefully regulated.