J Trauma
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We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. ⋯ Associated injuries are common in patients with scapular fractures. ISS and Abbreviated Injury Scale score for chest injuries are higher and posterior structure injuries are more frequent in patients with fractures involving multiple scapular regions.
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Head, face, and neck injuries (HFNIs) are an important source of combat mortality and morbidity. The objective of this study was to document the characteristics and causes of HFNIs during Operation Iraqi Freedom II. ⋯ The proportion of combat-related HFNIs is increasing and is primarily caused by IEDs. Improved protection for the vulnerable facial region is needed. Continued research on the changing nature of warfare and distribution of HFNIs is necessary to enhance the planning and delivery of combat casualty medical care.
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Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients. ⋯ The performance of our proposed BISS model was superior to that of the TRISS model in the populations under investigation. Nevertheless, given the ease of assessment and the objective value of the base deficit, it may be considered as a good method to predict outcome and evaluate care of trauma patients. Whether this can be translated to trauma patients in general needs further investigation.
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Controlled Clinical Trial
Continuous hemofiltration in hyperthermic septic shock patients.
Severe hyperthermia commonly accompanies septic shock. High body temperature in absence of infection activates the inflammatory response and is associated with a high mortality. Three years ago, our hypothesis that sustained fever is harmful in septic shock led us to the development of a protocol aiming at decreasing hyperthermia (>/=39.5 degrees C) by means of hemofiltration when the patients did not respond to antipyretics. We present a report of temperature and hemodynamic changes and the outcome of 19 consecutive hyperthermic septic shock patients with multiorgan system failure and compare them with a historical similar group of patients in whom hyperthermia was not treated with hemofiltration. ⋯ Continuous low-flow hemofiltration decreased body temperature and vasopressor requirements in hyperthermic septic shock patients. The mortality was unexpectedly low.
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Comparative Study
The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients.
Multidetector computed tomography (CT) is more sensitive and specific in detecting traumatic injuries than conventional radiology is. However, still little is known about the diagnostic value and the therapeutic impact of indicated thoraco-abdominal CT scan when it is performed in addition to the complete conventional radiologic work-up for blunt trauma patients. ⋯ CT scan of the chest and abdomen has a high diagnostic value in the evaluation of blunt trauma patients, when it is selectively performed in addition to the early conventional radiologic work-up. Unexpected pathologic findings are detected by CT scan in the majority of the patients. These findings result in an adaptation of treatment in a substantial number of the patients.