J Trauma
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Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA). ⋯ We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.
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Declining trauma operative experience adversely impacts learning and retention of operative skills. Current solutions, such as acute care surgery, may not provide relevant operative experience. We hypothesized that a structured skills curriculum using fresh cadavers would improve participants' self-confidence in surgical exposure of human anatomic structures for trauma. ⋯ A structured skills curriculum using fresh cadavers improved participants' self-confidence in operative skills required for surgical exposure of human anatomic structures for trauma. This model of training may be beneficial for surgical residents and fellows, as well as practicing trauma surgeons.
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The pericardial window in a focused assessment with sonography for trauma (FAST) examination is highly accurate for detecting hemopericardium and, therefore, associated cardiac injury. A series of patients with false-negative pericardial ultrasound examinations, who were subsequently diagnosed with cardiac lacerations after presenting with stab wounds, are described. ⋯ The pericardial component of the FAST examination is commonly used for patients who present with penetrating wounds to the precordium. In cases of concurrent lacerations of the pericardial sac, pericardial ultrasound may not detect a cardiac injury because of associated decompression into the thoracic cavity.
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With the onset of improved protective equipment against fragmentation, blast-induced neurotrauma has emerged as the "signature wound" of the current conflicts in the Middle East. Current research has focused on this phenomenon; however, the exact mechanism of injury and ways to mitigate the ensuing pathophysiology remain largely unknown. The data presented and literature reviewed formed the fundamentals of a successful grant from the U.S. Office of Naval Research to Wayne State University. ⋯ A physiologic- or biofidelic-based blast-induced tolerance curve may redefine current acceleration-based curves that are only valid to assess tertiary blast injury. Identification of additional pharmaceutical candidates will both confirm or deny current hypotheses on neural pathways of continued injury and help to develop novel prophylactic treatments.
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Trauma centers are increasingly tasked with evaluating patients who have sustained low-acuity mechanisms of injury, such as fall from standing (FFS). Previous studies have shown that low-level falls are associated with a high incidence of injury in certain patient groups. The purpose of the current study was to assess risk factors associated with brain injury and death after fall from the standing position only. ⋯ FFS is a potentially morbid mechanism of injury in those who are using warfarin, those with Glasgow Coma Scale score