J Trauma
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Recent years have seen a renewed interest in the use of hypertonic-hyperoncotic solutions as plasma volume expanders for the treatment of hemorrhagic hypotension. In particular, a number of studies in experimental animals have addressed the efficacy and safety of small-volume infusions of 7.5% NaCl/6% dextran 70 (HSD). ⋯ In the few human field trials completed to date, HSD has been shown to be potentially beneficial in hypotensive trauma patients who require surgery or have concomitant head injury. Extensive toxicologic evaluations and lack of reports of adverse effects in the human trials indicate that, at the proposed therapeutic dose of 4 mL/kg, HSD should present little risk.
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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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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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Retrospective analysis was performed on the medical records of 251 patients treated for cardiac injuries at Highland General Hospital trauma facility in Alameda County, California, to identify factors that contribute to patient survival and predict death. Thirty-six patients (14%) had blunt injuries, 153 patients (61%) had gunshot wounds (GSW), and 62 patients (25%) had stab wounds. ⋯ Stepwise multiple logistic regression analysis revealed that for patients with absent vital signs the only significant predictor of outcome was GSW as the mechanism of injury and for patients with vital signs the ISS and the presence of combined right and left heart injuries were significant independent predictors of outcome. We conclude that the routine and aggressive use of emergency room thoracotomy for patients with penetrating cardiac injury must be re-examined.
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Complications in trauma care occur because of provider-related or patient disease-related events. Strictly defined standardized definitions of both types of complications are needed to develop strategies for problem resolution. The frequency and characteristics of 135 disease-related and provider-related complications were examined for a 3-year period in a level I university trauma service in all patients meeting Major Trauma Outcome Study (MTOS) criteria. ⋯ Errors in technique were attributed to inexperience, haste, unfamiliarity with devices, lack of developed institutional techniques, and failure of providers to use recognized endpoints. Errors in judgment were attributed to failure to access available patient information, proceeding despite available information, and failure to utilize available care guidelines. Further reduction in provider-related morbidity in an organized trauma system requires this type of analysis, which identifies the need to change the process of care through education or adjustment of protocols for standardization care delivery in addition to the traditional focus on outcomes.