The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2012
Comparative StudyComparative functional outcome of AO/OTA type C distal humerus fractures: open injuries do worse than closed fractures.
Open distal humerus fractures present significant soft-tissue injury and bone devitalization that require prompt irrigation and debridement, temporization, and soft-tissue coverage. ⋯ When compared with closed fractures, open distal humerus fractures have worse functional outcome scores and decreased range of motion. Patients with open fractures also demonstrated a trend toward having higher complication rates, prolonged times to union, and higher rates of persistent nerve deficits requiring further surgery.
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J Trauma Acute Care Surg · Feb 2012
Impact of stress on resident performance in simulated trauma scenarios.
Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations. ⋯ In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.
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J Trauma Acute Care Surg · Feb 2012
Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma.
The optimal chest tube size for the drainage of traumatic hemothoraces and pneumothoraces is unknown. The purpose of this study was to compare the efficacy of small versus large chest tubes for use in thoracic trauma. Our hypothesis was that (1) there would be no difference in clinically relevant outcomes including retained hemothoraces, the need for additional tube insertion, and invasive procedures and (2) there would be an increase in pain with the insertion of large versus small tubes. ⋯ : II.
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J Trauma Acute Care Surg · Feb 2012
L-arginine infusion during resuscitation for hemorrhagic shock: impact and mechanism.
Our previous work showed a survival advantage with L-arginine (L-Arg) pretreatment in a swine model of severe hemorrhagic shock. This study was designed to evaluating whether the benefit is sustained when L-Arg is given during resuscitation and whether the mechanism is mediated by enzymatic activation of nitric oxide (NO) synthesis. ⋯ L-Arg infusion during resuscitation offers a significant functional, metabolic, and survival benefit after severe hemorrhagic shock.The mechanism seems to be by activation of NO synthesis with its attendant benefits to local perfusion and inflammation after global reperfusion.
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Computed tomography (CT) scans have become imaging modalities of choice in trauma centers. The purposes of this study were to evaluate the trend of radiation exposure in acute trauma patients. Our hypothesis was that radiation dosage and charges would increase over time without change in patient acuity or outcome. ⋯ III, retrospective.