Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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The purpose of this review is to examine existing research on oral contrast administrating as it pertains to the computed tomographic (CT) evaluation of blunt abdominal trauma, as well as to determine the necessity of oral contrast as part of a CT scanning universal protocol. Many hospitals routinely administer both oral and intravenous contrast prior to abdominal CT scan. There have been found to be numerous disadvantages and risks associated with oral contrast administration prior to CT scan. ⋯ However, the findings of the studies cited in this article are based on small sample sizes and low incidences of solid organ, bowel, or mesenteric injuries. The current level of available research has significant limitations to support a recommendation to eliminate the administration of oral contrast before obtaining the initial CT scanning for blunt abdominal trauma. Further research is necessary before any conclusion or practice change can be made.
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Inconsistent application of trauma service resources and underevaluation of risk and resuscitation status in elderly trauma patients are problematic. We describe a geriatric protocol that includes initial lactate determination and trauma surgery admission. Protocol compliance rates were initial lactate determination, 67.9%; trauma service admission for overt or compensated (elevated lactate) shock, 73.6%; and trauma service consultation for nonshock patients, 67.8%. Implementation of this protocol resulted in a trend toward reduced mortality and reduced potentially preventable deaths.