J Trauma
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Routine laboratory and radiology panels as part of the initial evaluation of the trauma patient are prevalent practices. This is a study of utility and cost effectiveness of this practice. ⋯ Routine panels are not useful or cost effective. Negative results contribute little to management. Selective and targeted studies should be indicated by the secondary survey, and may result in substantial cost savings ($1,500,000 per year at our institution).
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Optimal surgical treatment in elderly patients with type II odontoid fracture is still controversial. The purpose of this study is to investigate the surgical outcomes of anterior screw fixation of type II B odontoid fractures in the elderly. ⋯ The outcome of anterior odontoid screw fixation of type II B odontoid fractures in the elderly is satisfactory. We experienced satisfactory union rates and preserved cervical range of movement without the need of postoperative rigid neck immobilization. The morbidity associated with this procedure was low. We recommend anterior screw fixation as an effective method of treating type II B odontoid fractures in the elderly.
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Motor vehicle crashes remain a major cause of morbidity and mortality. Adolescents are disproportionately represented among victims. Several risk-reduction programs for teenage driving offenders have consequently been introduced. The efficacy of these interventions on subsequent driving behavior is unknown. We assessed the effectiveness of drive alive (DA), a 10-hour trauma center-based interactive program designed to reduce traffic violations in adolescents. ⋯ Participation in the DA program resulted in a lower rate of traffic violations in teenagers for a period lasting up till at least 6 months when compared with a control group. This effect is also seen in individuals referred for moving violations and alcohol-related offenses. Further research on educational intervention programs in interactive settings such as trauma centers is needed.
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Mechanical ventilation of intubated patients is standard to meet oxygenation and ventilation goals. This can require significant energy and oxygen resources. In military operations and mass casualty disasters, oxygen conserving strategies may be important. Low flow tracheal insufflation of oxygen (TRIO) is a technique that provides adequate oxygenation while conserving oxygen during apnea. This technique, however, is limited by increases in carbon dioxide (CO2) when used for extended periods. The addition of passive pressure release ventilation could potentially improve CO2 elimination and the acceptance of this technique. The purpose of this study was to determine whether TRIO combined with the novel configuration of a portable ventilator used to provide passive pressure release ventilation improves CO2 levels during apneic oxygenation. ⋯ The combination of low flow TRIO with a modified Oxylator in this novel configuration provides acceptable Pao2, Paco2, and hemodynamic parameters for 2 hours in apneic swine. This could be a valuable technique in situations where oxygen and power are limited.
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The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. ⋯ A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.