The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyMotion generated in the unstable cervical spine during the application and removal of cervical immobilization collars.
Many studies have compared the restriction of motion that immobilization collars provide to the injured victim. No previous investigation has assessed the amount of motion that is generated during the fitting and removal process. The purpose of this study was to compare the three-dimensional motion generated when one-piece and two-piece cervical collars are applied and removed from cadavers intact and with unstable cervical spine injuries. ⋯ There were statistically significant differences in motion between the one-piece and two-piece collars during the application process, but it was only 1.2 degrees in flexion/extension and 0.2 mm in anterior/posterior translation. Overall, the greatest amount of angulation and displacement observed during collar application was 3.4 degrees and 4.4 mm. Although the exact amount of motion that could be deleterious to a cervical spine-injured patient is unknown, collars can be placed and removed with manual in-line stabilization without large displacements. Only trained practitioners should do so and with great care given that some motion in all planes does occur during the process.
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyThe association between positive screen for future persistent posttraumatic stress symptoms and injury incident variables in the pediatric trauma care setting.
Posttraumatic stress (PTS) disorder after injury is a significant yet underaddressed issue in the trauma care setting. Parental anxiety may impact a child's risk of future, persistent PTS symptoms after injury. This study aimed to: (1) identify injury incident and demographic variables related to a positive screen for future, persistent PTS symptoms in children; and (2) examine the relationship between parental anxiety and a positive screen for future, persistent PTS symptoms in children. ⋯ Epidemiological study, level II.
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyTreatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid.
The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jun 2012
Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome.
Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyScrew- versus plate-fixation strength of acetabular anterior column fractures: a biomechanical study.
The standard for operative treatment of acetabular fractures is open reduction and plate fixation. Recently, screw fixation-only methods through less invasive approaches are reported, but biomechanical data are missing. Questions posed in this study are (1) is the static fixation strength of different screw types equivalent to the standard plate fixation for anterior column fractures of the acetabulum? and (2) does the placement of an additional screw in the infra-acetabular corridor increase the fixation strength independent of the used implant? ⋯ Therapeutic study, level IV.