J Trauma
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To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan. ⋯ A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.
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Occult fractures of the scaphoid bone occur frequently and may lead to nonunions. In a prospective blind study, we performed magnetic resonance imaging (MRI) examinations on 32 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected, but could not be confirmed on the original set of two routine and four scaphoid view radiographs. The MRI examinations were performed an average time of 2.8 days after the trauma. ⋯ Sensitivity and specificity of MRI were 100%. This conventional method could save $7,200 (US) per 100,000 inhabitants in providing an immediate and correct diagnosis and avoiding unnecessary cast immobilization. Additional injuries that may be misdiagnosed by conventional radiographs are also detected with a specificity and sensitivity of 100%.
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Case Reports
Compartment syndrome as a complication of skin traction in children with femoral fractures.
We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes after skin traction. Both children were admitted in our department for treatment of their compartment syndromes. ⋯ The causative role of the skin traction is proved since, in one infant, the compartment syndrome developed in the nonfractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.
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Provincial air ambulance transports of injured patients were quality reviewed prospectively to determine utilization and appropriateness of care. ⋯ A low overtriage rate was documented, raising concerns that the undertriage rate may be too high. Injured patients air transported without physician accompaniment more often received inappropriate care, suggesting that physician accompaniment is beneficial.
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Comparative Study
Rectal pH measurement in tracking cardiac performance in a hemorrhagic shock model.
We evaluated the utility of rectal mucosal pH measurement for tracking cardiac performance in hemorrhagic shock as compared with gastric tonometry. ⋯ Rectal mucosal pH tracks cardiac performance as well as does gastric tonometry in hemorrhagic shock without as many limitations.