J Trauma
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Epidural emphysema is a rare condition, and when occurs in isolation it is usually benign and resolves spontaneously after the underlying cause has been treated. Epidural emphysema is usually accompanied by pneumothorax, subcutaneous emphysema, or pneumomediastinum. ⋯ Although nonsurgical pneumoperitoneum can arise in different ways, generally pneumomediastinum or pneumothorax is observed in cases with an intrathoracic source. We report two cases of combined traumatic epidural emphysema and nonsurgical pneumoperitoneum in patients with pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema after blunt trauma.
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Burn patients with inhalation injury (INHI) require more fluid resuscitation than patients without INHI. However, the relation between INHI and fluid resuscitation may be confounded by a ventilation-induced increase in fluid retention. We therefore evaluated whether INHI was independently of continuous positive pressure ventilation (CPPV) associated with increased fluid retention. ⋯ These results suggest that increased fluid retention, which is conventionally associated with INHI, is due to the effects of ventilation and not to the effects of INHI itself. This warrants a closer evaluation of patients who are ventilated in the absence of INHI, with a view to early extubation.
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Preload parameters in postresuscitation phase are not sufficiently sensitive to guide fluid therapy in critically ill patients. We analyzed modifications in the fluid therapy and vasoactive drugs of critically ill patients that were produced by inclusion of extravascular lung water (EVLW) data in the treatment protocol and evaluated the short-term response. ⋯ Quantification of EVLW in patients who can be considered euvolemic induces important modifications in fluid and vasoactive therapy. These changes generally resulted in a lower volume loading and a positive outcome for the patient.
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Pulseless electrical activity (PEA) secondary to both blunt and penetrating trauma is associated with minimal survival. The pericardial view of the focused abdominal sonography for trauma (p-FAST) can differentiate between patients with and without organized cardiac activity and may assist in the decision to terminate ongoing resuscitation. ⋯ The presence of PEA at any time during initial resuscitation is a grave prognostic indicator. p-FAST is a useful test to identify contractile cardiac activity. p-FAST may identify those patients with potential for survival.
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Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. ⋯ Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.