J Trauma
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To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries. ⋯ Scene flights in this metropolitan area for patients who suffered noncranial penetrating injuries demonstrated that these flights were not medically efficacious. This conclusion rests on the findings that arrival at a trauma center was not hastened by scene flights and that only 4.9% of patients required prehospital care by the medical flight crew beyond the capabilities of the first-responding EMS personnel (2.5 and 6.7% for ALS and BLS responders, respectively). Based on this experience, we believe that in metropolitan areas, scene flights for victims of noncranial penetrating injuries should be restricted to critically injured patients likely to require prehospital care by the medical flight crew that is beyond the capabilities of the first responders or when the scene flight is likely to significantly hasten the arrival of the injured patient to an appropriate trauma center.
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Cycle safety helmets are designed to prevent head injury. Although most commercially available helmets conform to one of several national and international standards, individual designs differ widely, particularly in relation to face coverage. A method was developed to assess the potential for the differing designs to protect the face from injury. ⋯ It was concluded that the dimensions of cycle helmets in relation to face coverage are crucial in influencing the extent to which facial protection is conferred. International test standards need urgent revision to ensure that face coverage is optimized. Lower-face protection could be achieved through incorporation of a lower-face bar to cycle helmets.
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Randomized Controlled Trial Clinical Trial
Oxandrolone, an anabolic steroid, significantly increases the rate of weight gain in the recovery phase after major burns.
We studied the effect of an anabolic steroid, oxandrolone, combined with a high-protein diet (2 g/kg/day) on the rate of weight gain and restoration of muscle function in the recovery phase after deep burns of 30 of 50% of total body surface (n = 7). The findings were compared with findings from an isocaloric (2 g/kg/day protein) diet alone (n = 6). The study was prospective and randomized. ⋯ Protein content and oxandrolone were the variables. No side effects were noted with oxandrolone. We can conclude that an anabolic steroid combined with increased protein intake can significantly increase the rate of restoration of weight gain postburn.
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Computed tomography of the chest (CTC) is more sensitive than conventional roentgenography at detecting blunt thoracic injuries. Its effect on subsequent therapy remains incompletely characterized. ⋯ Blunt thoracic injuries detected by CTC infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine CTC in blunt trauma is not recommended but may be helpful in selected cases.
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Management of deep dermal hand burns represents a difficult clinical problem for the burn team because bedside estimation of burn depth is unreliable. Early identification of full-thickness injury and prolonged healing times might result in the decision to perform surgical excision of eschar and skin grafting of the wounds. Such a strategy may improve overall functional and cosmetic results of hand burn treatment. ⋯ Laser Doppler flowmetry may serve as a valuable adjunct to the prediction of the need for grafting and time to wound closure. Standardization of flowmetry data and techniques of evaluation are desirable. Spontaneous healing should be the goal in the majority of deep dermal hand burns.