Articles: trauma.
-
The technique or approach of damage control surgery in trauma is not new; packing liver injuries has been an accepted treatment strategy for some time. What is new is the realization that an abbreviated laparotomy, or completion of only the essential portions of the operation, is often the best treatment for the patient as a whole. Recent developments include strategies in the operating room and the intensive care unit to manage patients undergoing trauma laparatomy, including prevention of hypothermia, methods to accurately assess resuscitation status with right ventricular catheters and measurements of end-organ perfusion, and recognition of abdominal compartment syndrome, with emphasis on prevention.
-
Pediatr Crit Care Me · Jul 2000
Biochemical, cellular, and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: Lessons learned from the bedside.
To present a state-of-the-art review of mechanisms of secondary injury in the evolution of damage after severe traumatic brain injury in infants and children. DATA SOURCES: We reviewed 152 peer-reviewed publications, 15 abstracts and proceedings, and other material relevant to the study of biochemical, cellular, and molecular mechanisms of damage in traumatic brain injury. Clinical studies of severe traumatic brain injury in infants and children were the focus, but reports in experimental models in immature animals were also considered. Results from both clinical studies in adults and models of traumatic brain injury in adult animals were presented for comparison. DATA SYNTHESIS: Categories of mechanisms defined were those associated with ischemia, excitotoxicity, energy failure, and resultant cell death cascades; secondary cerebral swelling; axonal injury; and inflammation and regeneration. ⋯ A constellation of mediators of secondary damage, endogenous neuroprotection, repair, and regeneration are set into motion in the brain after severe traumatic injury. The quantitative contribution of each mediator to outcome, the interplay between these mediators, and the integration of these mechanistic findings with novel imaging methods, bedside physiology, outcome assessment, and therapeutic intervention remain an important target for future research.
-
Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. ⋯ Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. [Seipmann DB, Mann NC, Hedges JR, Daya MR, for the Rapid Early Action for Coronary Treatment (REACT) Study. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med. June 2000;35:573-578.].
-
Comparative Study Clinical Trial
Somatosensory evoked potential monitoring during closed humeral nailing: a preliminary report.
To assess the role of intraoperative somatosensory evoked potential (SSEP) monitoring of the radial and median nerves in preventing iatrogenic nerve injury during closed, locked intramedullary (IM) nailing of the humerus. ⋯ Intraoperative radial nerve SSEP monitoring appears to reliably reflect the status of the radial nerve in those patients with a humerus fracture. In three of eleven patients, intraoperative signal changes prompted a change in surgical plan. In no patient did there appear to be evidence of iatrogenic nerve injury.