J Trauma
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Traumatic abdominal wall hernia (TAWH) is an uncommon injury. Handlebar hernia represents one type of TAWH: handlebar hernia is caused by low-energy impact against a small blunt object, can be detected by physical examination, and is infrequently associated with other significant injury. Surgical repair is recommended.
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Comparative Study
Blood transfusions: for the thermally injured or for the doctor?
Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. ⋯ Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.
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A three-year retrospective and prospective study was conducted in the North Coast EMS Region of California to evaluate the effectiveness of a rural trauma program and its impact on patient outcome. Two hundred sixty-six patients with major trauma were identified. Age, hospital and prehospital Trauma Scores (TS), Revised Trauma Scores (RTS), Injury Severity Scores (ISS), and Mechanism of Injury (MOI) were recorded. ⋯ Blunt trauma accounted for the majority of injuries (82.1%) and the primary cause was motor vehicle crashes (63.8%). The z (mortality) and M statistics were -2.33 (p = 0.020) and 0.66, respectively. Thus a significant improvement in survival rates resulted compared with MTOS baseline norms.
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Avulsion of the anterior-superior iliac spine rarely occurs in adolescents. The condition is commonly encountered in athletes. ⋯ We report on avulsion in two young athletes treated by open reduction and internal fixation, which enabled them to resume sports: one 3 weeks and the other 4 weeks after the injury. Treatment by open reduction and internal fixation is also indicated in patients requiring a short convalescence.
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The accuracy and reliability of the relationship between arterial and end-tidal carbon dioxide (PETCO2 and PaCO2), expressed as the gradient, P(a-ET)CO2, was assessed with 171 comparisons in nine mechanically ventilated trauma patients. The P(a-ET)CO2 was 14 +/- 11 mm Hg. (mean +/- standard deviation.) The positive correlation between PaCO2 (44 +/- 10 mm Hg) and PETCO2 (30 +/- 10 mm Hg) for the study population (reflected by r = 0.64, p = 0.001; but r2 = 0.41) indicated statistical significance, but only 40% of the changes reflected a linear relationship. ⋯ Changes in PETCO2 erroneously predicted the PaCO2 changes in 27% of comparisons with 15% false decreases and 12% false increases. Trends in P(a - ET)CO2 magnitude are not reliable, and concordant direction changes in PETCO2 and PaCO2 are not assured.