J Trauma
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Meta Analysis
Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis.
There is a subset of blunt trauma patients that present with symptoms suspicious for cervical spine injury or with unreliable clinical exams whose initial plain radiographs or cervical computed tomography (CT) scan are negative. Uncertainty remains, however, because no gold standard has been established for definitively clearing the cervical spine of injury in this patient cohort. Individual studies have detailed the use of magnetic resonance imaging (MRI) in this patient population without conclusive results. ⋯ A magnetic resonance image that did not disclose anything abnormal can conclusively exclude cervical spine injury and is established as a gold standard for clearing the cervical spine in a clinically suspicious or unevaluatable blunt trauma patient. An accurate number of false positive MRI scans cannot be determined.
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The use of "care bundles" in the prevention of ventilator-associated pneumonia (VAP) and other intensive care unit (ICU) complications have been increasingly used in critical care practice. However, the effective implementation of these strategies represents a challenge in a busy Level I trauma ICU. We devised a daily "Quality Rounds Checklist" (QRC) tool for use in the ICU to increase compliance with these prophylactic measures and identify areas for improvement in quality of care. ⋯ Introducing a daily QRC tool facilitated improved compliance rates for 16 clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of this tool, requiring just a few minutes per patient to complete, results in a sustainable improvement in patient outcomes.
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Although literature regarding emergency department thoracotomy (EDT) outcome after abdominal exsanguination is limited, numerous reports have documented poor EDT survival in patients with anatomic injuries other than cardiac wounds. As a result, many trauma surgeons consider prelaparotomy EDT futile for patients dying from intra-abdominal hemorrhage. Our primary study objective was to prove that prelaparotomy EDT is beneficial to patients with exsanguinating abdominal hemorrhage. ⋯ Despite critical injuries, 16% survived hospitalization, neurologically intact, after EDT for abdominal exsanguination. Our results suggest that prelaparotomy EDT provides survival benefit to penetrating trauma victims dying from intra-abdominal hemorrhage.
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Elevation of serum troponin (cTnI) after nontraumatic cerebral insult has been associated with an adverse prognosis. This association has not been well documented in traumatic brain injury (TBI). ⋯ Elevated TnI is frequently observed after severe TBI. The level of TnI correlates with the severity of head injury and is an independent predictor of adverse outcomes. BB therapy is associated with a survival advantage in TBI patients with elevated cTnI.