J Trauma
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The clinical features and successful management of a patient with right main bronchus disruption after blunt chest trauma are described. The presentation was one of bilateral tension pneumothoraces. A high index of suspicion, coupled with appropriate airway management at presentation, was vital for the successful treatment of this patient. Surgical resection using a sleeve lobectomy, an operation rarely used in trauma patients, was highly effective in this patient, and the technique is described in this report.
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Inappropriate use of helicopter transport of trauma patients in urban areas increases costs, risk of injury, and unavailability for appropriate flights. We evaluated the effect of an emergency medical service (EMS) system audit of helicopter trauma scene flights (TSFs) on appropriateness of TSFs. ⋯ An EMS system audit with general awareness of audit criteria decreased the total number of TSFs and hence the number of INAPPRO TSFs in this urban trauma system population. However, the proportion of TSFs that were considered INAPPRO did not change. Criteria for urban TSFs should be based on markers of critical physiologic patient status matched to unique care that the helicopter personnel can provide (e.g., advanced airway management).
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Review Case Reports
Aortic dissection after trauma: case report and review of the literature.
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To determine the nature and causes of gun violence among urban young people. ⋯ Handgun availability and use are high among urban youth; gun carrying is mostly related to safety concerns and easy access, rather than to hunting or sport. This may be a cause of high handgun injury rates in this group. Gun injury prevention programs must address youth safety concerns along with handgun availability.
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To study hemodynamic effects of growth hormone (GH) and its main mediator, insulin-like growth factor-1, in a model of critical illness. ⋯ GH promoted metabolic acidosis in traumatized sepsis and impaired compensation of a subsequent hemorrhage.