J Trauma
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To evaluate whether aeromedical transport of trauma patients who sustain an out-of-hospital cardiac arrest (OHCA) is justified. ⋯ These results suggest that: (1) trauma patients who are resuscitated to a sinus rhythm after OHCA should be transported to a trauma center; (2) Revised Trauma Score and Injury Severity Score are useful to predict survival; and (3) neurologic outcome is not accurately predicted by this model.
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To describe the epidemiology of severe assault and gun injuries to children in an urban population and consider the impact of a comprehensive injury prevention program. ⋯ Comprehensive interventions may be effective in curbing the incidence of severe assault injuries to urban youth. Further controlled evaluations are needed to confirm the effectiveness of programs such as this and to better understand the prevention of violent injuries.
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Severe injury is frequently complicated by sepsis and organ failure. Activated neutrophils adherent to inflamed endothelia have been implicated in the pathogenesis of these complications. Identification of high-risk patients to target immunomodulatory therapy, however, remains an elusive goal. We postulated that (1) patients at risk for sepsis and organ failure could be identified by measuring shed selectin adhesions molecules as a marker of endothelial activation after injury and reperfusion, and (2) these elevated selectin levels would correlate with injury severity, shock, major complications, and mortality. ⋯ A subset of major trauma patients manifest increased levels of circulating E-selectin adhesion molecules after resuscitation. These patients seem to be at increased risk of death and possibly at risk for infections complications and organ failure. Selectin blockade is a potential new immunomodulatory strategy in this subgroup of patients.
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This study summarizes all 2,550 trauma-related rural ambulance trip reports filed for the period January 1 through December 31, 1991 from the 12 rural counties surrounding Augusta, Georgia. There were 13.1 trauma-related ambulance runs per 1,000 population. Nearly one third of all rural ambulance runs are trauma related. ⋯ Only 51.5% of runs had a rural hospital as a destination, 14.2% went directly to a trauma center, and nearly 20% to another urban hospital. Of the 71 severe trauma cases received by ambulance, rural hospitals transferred out only 13 cases, most of these to the regional trauma center. Of the 47 trauma cases transferred to the trauma center, 33 were not severe.
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To determine the relationship between the prognosis of seriously injured patients requiring emergency surgery and intraoperative end-tidal CO2 variables and "excess Pco2." ⋯ Values derived from the end-tidal CO2 and the excess Pco2 should be monitored intraoperatively in critically injured patients. Efforts should be made to improve cardiac output and adjust ventilation to maintain an end-tidal Pco2 of 25 mm Hg or more, an arterial to end-tidal CO2 difference of 12 mm Hg or less, and an excess Paco2 of 1.0 mm Hg or less.