J Trauma
-
To evaluate our developed volume supplement protocol in preventing hypernatremia after head injury. ⋯ Our protocol worked effectively in patients in whom renal function was preserved. Decreased creatinine clearance because of preexisting dehydration and lower arterial pressure disturbed increase in urinary sodium excretion and temporarily aggravated the hypernatremia.
-
Previous studies have reached contradictory conclusions regarding where injured children are best treated. Our hypothesis was that no differences in survival outcome exist among trauma centers caring for pediatric patients. ⋯ The improved unexpected outcome results at Level I centers and centers with Added Qualifications in Pediatrics suggest that a team of qualified professionals working in an institution willing to commit the required resources can sufficiently offer injured children the survival advantage expected of a trauma center.
-
This study evaluated processes of care and outcome for injured patients at a Level I trauma center who had been either treated as a full trauma team activation (FULL) or managed with a modified trauma team activation (MOD). ⋯ Implementation of the tiered response protocol led to a substantial change in the operational response in the emergency department. Although processes of care were nominally prolonged, adverse consequences were not identified. We concluded from this quality improvement review that implementation of a tiered response protocol was satisfactory and improved efficiency. Further work is required to improve accuracy of the categorization of trauma system patients as either MOD or FULL trauma codes.
-
Existing shock models do not address the patient with massive hemorrhage (> 1 blood volume). Such patients often die from irreversible shock. This model simulates the clinical scenario of massive hemorrhage and resuscitation (MHR) to determine if irreversible shock can be reversed. ⋯ This MHR model is much more lethal than a traditional severe hemorrhage model and reproduces the clinical picture of irreversible shock. This irreversible shock can be reversed with very large volumes of resuscitation.