J Trauma
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Randomized Controlled Trial Multicenter Study Comparative Study
Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.
In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position. ⋯ Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.
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The perfect degree of operative intervention in renal trauma is unknown. However, expectant management for most blunt renal trauma is the standard of care, and nonoperative management is increasingly accepted for stab wounds. The best treatment of gunshot wounds and vascular injuries is still unclear; however, recent data indicates that a trial of nonoperative therapy may be warranted in those not exsanguinating from the kidney. Conservative management has many benefits, the greatest of which is decreasing the rate of iatrogenic nephrectomy. We have reviewed the world's literature to determine the level of support for expectant management of renal injury. ⋯ Dozens of papers going back as far as 50 years seem to support the wider use of nonoperative therapy of renal injuries, although for unclear reasons, this approach is not yet universally accepted.
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The data regarding trauma recidivism among youth suggest that alcohol and/or substance abuse counseling should be an integral part of an injury prevention program in Level I trauma centers. Analysis of attitudes and motivation toward changing substance use is an important part of counseling. This study explores the willingness of a patient population at risk for recurrent injury to address their alcohol or substance use habits. ⋯ Although findings regarding the assessment of attitudes toward readiness to change among young drug/alcohol-using patients experiencing penetrating trauma were initially very encouraging, facilitating and engaging these patients in actual behavior changing activities was far more challenging. Further exploration into the existing barriers to accessing treatment services and cultivating attitudes toward changing substance use behaviors is necessary.
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Case Reports
Functional outcome after operative treatment of eight type III coronoid process fractures.
There have been few reports about surgical outcomes of coronoid process fractures. Eight cases of clinical results of type III coronoid process fractures were reviewed. ⋯ Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated injuries to the elbow and fracture comminution were considered as important prognostic factors.
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Flexion-extension roentgenograms (FER) of the cervical spine are often inadequate because of limited range of motion (ROM). The purpose of this study was to determine the utility of goniometry to predict a patient's ability to achieve sufficient ROM to obtain adequate FER. ⋯ Goniometry accurately predicted those patients who were unable to achieve sufficient ROM for adequate FER. Patients with inadequate FER were at a higher risk for cervical spine injury compared with patients with adequate FER (23.0 versus 7.69%). Early identification of these patients will help limit the number of inadequate studies obtained and expedite evaluation of high-risk patients.