J Trauma
-
Using in-depth, real-world motor vehicle crash data from the United States and the United Kingdom, we aimed to assess the incidence and risk factors associated with thoracic aorta injuries. ⋯ Aortic injuries have been conventionally associated with frontal impacts. However, emergency clinicians should be aware that occupants of side-impact crashes are at greater risk, particularly if the occupant was unbelted and involved in a crash of high impact severity.
-
Adult respiratory distress syndrome develops in up to 20% of patients with severe head injury. This complicates the treatment of head-injured patients because lung-protective strategies such as high positive end-expiratory pressure (PEEP) and permissive hypercapnia may increase intracranial pressure (ICP) and reduce cerebral perfusion pressure. The use of high-frequency percussive ventilation (HFPV) is an alternate mode of ventilation that may improve oxygenation for head-injured patients while also lowering ICP. ⋯ Therapy with HFPV produced a significant improvement in oxygenation with a concomitant reduction in ICP during the first 16 hours. This therapy may represent an important new method for the management of adult respiratory distress syndrome among head-injured trauma patients, although the long-term outcome of HFPV still needs evaluation.
-
Critically ill nonverbal patients often have limited means of communication through eye-blinking, communication cards, and occasionally writing. We evaluated a novel computer communication device to determine its clinical utility as an alternative form of communication between patients and hospital staff. ⋯ The system evaluated offers an effective alternative to traditional means of communication in the intensive care unit. Computer-assisted communication improves patient comfort and allows advanced patient participation in medical care. Further studies will determine whether this modality objectively improves patient care by promoting a higher degree of safety and reducing medical errors.
-
Randomized Controlled Trial Clinical Trial
Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients?
An analysis from the prospective multicenter randomized controlled trial (Transfusion Requirements in Critical Care Trial) compared the use of restrictive and liberal transfusion strategies with resuscitated critically ill trauma patients. ⋯ A restrictive red blood cell transfusion strategy appears to be safe for critically ill multiple-trauma patients. A randomized controlled trial would provide the appropriate level of evidence with regard to the daily use of blood in this population of patients.
-
Review
Integrating emergency general surgery with a trauma service: impact on the care of injured patients.
There has been considerable discussion on the national level on the future of trauma surgery as a specialty. One of the leading directions for the field is the integration of emergency general surgery as a wider and more attractive scope of practice. However, there is currently no information on how the addition of an emergency general surgery practice will affect the care of injured patients. We hypothesized that the care of trauma patients would be negatively affected by adding emergency general surgery responsibilities to a trauma service. ⋯ Despite an increase in trauma volume over the study period, the addition of emergency surgery to a trauma service did not affect the care of injured patients. The concept of adding emergency surgery responsibilities to trauma surgeons appears to be a valid way to increase operative experience without compromising care of the injured patient.