J Trauma
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Comparative Study
The effects of hypothermia and injury severity on blood loss during trauma laparotomy.
To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < or = 35 degrees C) upon arrival in the OR. ⋯ Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.
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Review
The 1991 Fraser Gurd Lecture: evolution of airway control in the management of injured patients.
The evolution of methods for airway control has been an important factor in improving overall trauma care. Many important advances have been made in technique, tubes, and timing. Current methods of airway control are listed in Table 2 and are categorized as emergency or elective. ⋯ The role of differential ventilators in the management of unilateral pulmonary parenchymal injury requires clinical validation. Intravascular membrane oxygenators have been proposed in advanced pulmonary insufficiency in a ventilated patient. Thus, while many important strides have been made in airway management following trauma, there remain great challenges in addressing the persistent problem of systemic hypoxemia after multiple injuries.
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Review Case Reports
Appendiceal transection in a child associated with a lap belt restraint: case report.
The seatbelt syndrome refers to the spectrum of injuries associated with lap belt restraints and includes intestinal tears, perforations, and transections; mesenteric disruptions; and lumbar distractions, dislocations, and fractures. We report a case of appendiceal transection associated with a lap belt restraint in a small child.
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The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. ⋯ Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.
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Two hundred sixty-six of 374 consecutive blunt trauma patients underwent emergency computed tomographic (CT) scanning during evaluation at a level I trauma center. The purpose of this study was to develop guidelines for use of CT scanning in the initial evaluation of blunt trauma patients. Of the 131 CT scans of the head obtained, 20 (15%) had positive results. ⋯ Chest CT scans provided information about the extent of the injury but did not alter the initial management of any patient and therefore are rarely indicated in the acute evaluation of trauma patients. A total of 110 abdominopelvic CT scans were performed and 20 (19%) were interpreted as positive. Seventy-five percent of those patients with positive CT scans were treated successfully in a nonsurgical fashion.