J Trauma
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The goal of this study was to determine the rate of preventable mortality and inappropriate care in cases of traumatic death occurring in a rural state. ⋯ The rural preventable death rate from trauma is not dissimilar to that found in urban areas before the implementation of a trauma care system. Inappropriate care rendered in the emergency department related to airway and chest injury management occurs at a high rate. This seems to be the major contributor to preventable trauma deaths in rural locations. Education of emergency department primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in the rural setting.
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The aims of this study were to determine if angiographic findings can be used to predict successful nonoperative therapy of splenic injury and to determine if coil embolization of the proximal splenic artery provides effective hemostasis. ⋯ (1) Hemodynamically stable patients with splenic injuries of all grades and no other indications for laparotomy can often be managed nonoperatively, especially when the injury is further characterized by arteriography. (2) The absence of contrast extravasation on splenic arteriography seems to be a reliable predictor of successful nonoperative management. We suggest its use to triage CT-diagnosed splenic injuries to bed rest or intervention. (3) Coil embolization of the proximal splenic artery is an effective method of hemostasis in stabilized patients with splenic injury. It expands the number of patients who can be managed nonoperatively.
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Case Reports
Internal mammary artery injury, anterior mediastinal hematoma, and cardiac compromise after blunt chest trauma.
A rare case of blunt chest trauma resulting in internal mammary artery hemorrhage and cardiac tamponade is presented. Thoracotomy revealed anterior mediastinal hemorrhage but no pericardial hematoma. The significance of chest wall vessel hemorrhage as a cause of widened mediastinum is reiterated. The importance of accurate angiographic assessment and vigilant care of victims of blunt chest trauma who present with a widened mediastinum is emphasized.
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The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. ⋯ In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.