J Trauma
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This prospective study evaluated the use of basic vital signs, two mechanisms of injury, and time-distance factors as field triage criteria for on-scene helicopter transport of 130 patients to a trauma center serving a rural area. The vital signs criteria included any one or more of the following: level of consciousness (LOC) less than or equal to unresponsive to verbal stimulation; respiration rate (RR) less than or equal to 10 or greater than or equal to 30; systolic blood pressure (BP) less than or equal to 90; pulse (P) less than or equal to 60 or greater than or equal to 120. The flight crew recorded vital signs taken by the first responder capable of basic assessment. ⋯ The presence of one or more abnormal signs identified a group of seriously injured trauma patients (mean Injury Severity Score = 29.1) with 24% mortality compared to a predicted mortality of 32% (p less than 0.02). Unresponsiveness to verbal stimulation in the field was the single most predictive criterion, yielding sensitivity of 93% and specificity of 85%. Time-distance criteria were helpful to determine helicopter use.
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Twenty-six individuals with second- and third-degree burn wounds have been grafted with cultured allogeneic epidermal cells. These epidermal cell grafts were grown in culture from cadaver skin according to a technique which we have developed. After being grafted with cultured allogeneic epidermal cells, superficial wounds, e.g., donor sites, healed within 7 days, compared to 14 days for mirror image control sites. ⋯ The cultured cells produced rapid healing in 11 of the 12 patients with deep second-degree burn wounds. The deep second-degree wounds grafted with cultured allogeneic epidermal cells healed with results which were comparable to the deep second-degree wounds which were autografted. Grafts of cultured allogeneic epidermal cells placed on full-thickness, or third-degree burn, wounds did not grow well.
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A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. ⋯ Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.
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Ninety-four cases of percutaneous tracheostomy and six cases of percutaneous cricothyroidotomy are reported in this study. There was one death attributable to the use of the device. A complication rate of 14% is reported. ⋯ Autopsies on 14 of these patients are discussed. Long-term followup, that is for 1 year and more, is reported in 19 cases. Advantages of the percutaneous technique over the standard dissection technique are detailed.
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A mandatory seatbelt use law, the first such law in the nation, became fully in force in New York State as of 1 January, 1985. We studied seatbelt use among drivers and front seat passengers involved in motor vehicle accidents for a 3-month period pre-legislation (Phase 1), and a 5-month period post-legislation (Phase 2), to determine if this type of compulsory law, providing civil fines of $50 for violators, changes seatbelt use behavior. ⋯ A highway survey (Phase 3) noted the use rate in New York City and surrounding counties to be 63%, a marked increase from the published pre-legislation value of 16%. We conclude that mandatory seatbelt use legislation is effective in significantly increasing seatbelt use and urge physicians to seek similar legislation in every state.