The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Nov 2015
Biography Historical ArticleA medical history of Governor John B. Connally and his gunshot wounds.
: On November 22, 1963, the Governor of Texas, John Connally, was injured during the assassination of President John F. Kennedy. ⋯ However, the injuries sustained by Governor Connally have been overlooked by historians predominantly because of the extraordinary importance of the presidential assassination and its impact on the national consciousness. This review discusses the governor's political life, the mechanism of injury, his medical care, and the role the injuries had on his subsequent public life.
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J Trauma Acute Care Surg · Nov 2015
Randomized Controlled Trial Comparative StudyImpact of common crystalloid solutions on resuscitation markers following Class I hemorrhage: A randomized control trial.
Resuscitation after hemorrhage with crystalloid solutions can lead to marked acidosis and iatrogenically worsen the lethal triad. The effect of differing solutions on base deficit and lactate has been sparsely prospectively studied in humans. We sought to quantify the effect of normal saline (NS) and lactated Ringer's (LR) resuscitation in voluntary blood donors as a model for Class I hemorrhage. ⋯ Therapeutic study, level II.
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Hospital readmissions are a frequent challenge. Speculation exists that rates of readmission following traumatic injury will be publicly disclosed. The primary aim of this study was to characterize and model 1-year readmission patterns to multiple institutions among patients originally admitted to a single, urban Level I trauma center. Additional analyses within the superutilizers subgroup identified predictors of 30-day readmissions as well as patient loyalty for readmission to their index hospital. We hypothesized that hospital readmission among trauma patients would be associated with socioeconomic, demographic, and clinical features and superutilizers would be identifiable during initial hospitalization. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Nov 2015
Observational StudyRedefining "dead on arrival": Identifying the unsalvageable patient for the purpose of performance improvement.
Significant variation exists across registries in the criteria used to identify patients with no chance of survival, with potential for profound impact on trauma center mortality. The purpose of this study was to identify the optimal case definition for the unsalvageable patient, for the purpose of exclusion from performance improvement (PI) endeavors. ⋯ The PROXY case definition has excellent predictive utility to identify patients who, based on presenting vital signs, will go on to die. PROXY should be used to exclude unsalvageable patients from PI endeavors.
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J Trauma Acute Care Surg · Nov 2015
The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study.
Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. ⋯ Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures.