Arch Surg Chicago
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The concept of multiple organ failure and related abnormalities was first developed in the 1970s. Multiple organ failure became evident when the support systems in intensive care units were able to keep patients alive long enough for multiple organ problems to develop in them. ⋯ These trials have had either limited success or negative results, despite considerable evidence for efficacy or protection by such agents in experimental animals and in studies of normal human volunteers. I believe a major reason for these negative results has been the use of general entry criteria for the trials rather than the treatment of specific diseases or injuries.
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To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes. ⋯ Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.
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To measure the effect of prehospital endotracheal intubation on outcome in patients with severe head injury and the percentage of these patients intubated in the field under existing protocol. ⋯ Prehospital endotracheal intubation was associated with improved survival in patients with blunt injury and scene Glasgow Coma Score of 8 or less, especially those with severe head injury by anatomic criteria. Broadening indications for intubation by paramedical personnel has great potential to improve outcome in patients with severe head injury.
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To identify computed tomographic (CT) findings in children who have experienced blunt trauma and who have known intestinal injuries and to correlate these findings with the findings of the initial physical examination. ⋯ The initial physical examination findings and CT evaluation can independently identify the presence of intestinal injury in approximately 25% of cases. In the remainder of cases, the awareness of the more subtle findings of bowel injury on a CT scan can complement the physical examination findings and potentially lead to a more timely intervention for bowel injury.
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To assess the impact of intravenous (IV) antibiotic prophylaxis on the incidence of pancreatic infection and the mortality rate in severe acute pancreatitis. ⋯ Intravenous antibiotic prophylaxis significantly reduced the infection rate in severe acute pancreatitis, with only a trend toward improved survival. A prospective, randomized, double-blind multicenter trial comparing the efficacy of different types and/or combinations of antibiotic prophylaxis in severe acute pancreatitis is indicated.