J Trauma
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Randomized Controlled Trial Clinical Trial
Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use.
Occult pneumothorax is defined as a pneumothorax that is detected by abdominal computed tomographic (CT) scanning, but not routine supine screening chest roentgenograms. Forty trauma patients with occult pneumothorax were prospectively randomized to management with tube thoracostomy (n = 19) or observation (n = 21) without regard to the possible need for positive pressure ventilation, to test the hypothesis that tube thoracostomy is unnecessary in this entity. ⋯ Hospital and ICU lengths of stay were not increased by tube thoracostomy. Patients with occult pneumothorax who require positive pressure ventilation should undergo tube thoracostomy.
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One hundred eight femoral shaft fractures in one hundred six adults were treated by closed intramedullary interlocked nailing. Ninety-two fractures were severely comminuted and 16 fractures were segmental. The procedures were done with the patients in the supine position. ⋯ There were two postoperative complications, which did not ultimately affect the clinical results. No infections or delayed unions were observed. Closed intramedullary interlocked nailing seems to be the treatment of choice for comminuted and segmental fractures of the femoral shaft provided that all the technical details are followed by the surgeon.
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Prolonged hemorrhagic shock is characterized by the progression from hyperglycemia to hypoglycemia and failure to respond to standard methods of resuscitation. Previous studies have shown that the transition to irreversible shock is accompanied by attenuation of hepatic gluconeogenic capacity and a rising level of intracellular calcium. Additionally, it has been observed that diltiazem improves survival following prolonged hemorrhagic shock in rats. ⋯ In group A, hepatic glucose production was significantly elevated in DZ animals when compared with controls (p < 0.05). A similar significant improvement in gluconeogenesis was observed following 120 minutes of hemorrhagic shock in group B (p < 0.05). Additionally, treated rats (DZ, both groups A and B) demonstrated improved gluconeogenic response to substrate when compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation.
To analyze the effect on mortality of a protocol for early mobilization with external fixation of patients with pelvic ring injuries. ⋯ An organized protocol including external fixation and early patient mobilization to an upright chest position reduced mortality associated with injuries of the pelvic ring. Orthopedic stabilization of major skeletal injuries should be viewed as part of patient resuscitation, not reconstruction.