J Trauma
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Multicenter Study
Helicopter transport and blunt trauma mortality: a multicenter trial.
Despite many studies addressing potential impact of helicopter transport on trauma mortality, debate as to the efficacy of air transport continues. ⋯ The results of this study are consistent with an association between helicopter transport mode and increased survival in blunt trauma patients.
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Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed. ⋯ Flexion-extension studies were not a cost-effective part of the protocol, and they were dropped.
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The Institute of Medicine has recommended intraosseous (IO) infusion of 7.5% hypertonic saline (HTS) for combat casualties in shock. We tested the safety and efficacy of this recommendation in a long-term survival model of uncontrolled hemorrhagic shock using dehydrated swine. ⋯ HTS resuscitation effectively restored hemodynamic stability in dehydrated swine without increased bleeding from an uncontrolled vascular injury. However, IO infusion of HTS in this model was associated with a very high rate of local complications. Further investigations should be undertaken before IO use of 7.5% HTS in humans.
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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). ⋯ In this pilot study, StCO2 correlated significantly with CPP. A StCO2 > or = 75 suggests that CPP is adequate, while < 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
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This study assessed patients with traumatic brain injury (TBI) to determine whether prehospital and community hospital providers employed hyperventilation therapy inconsistent with consensus recommendation against its routine use. ⋯ Prehospital and community hospital hyperventilation practices are not consistent with consensus recommendations for limitation of hyperventilation therapy.