J Trauma
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It is important for preventing hyperventilation so as to improve the outcomes of patients with severe traumatic brain injuries. End-tidal CO2 (Petco2) reflects arterial CO2 (Paco2), noninvasively and continuously. The aim of this study is to examine the concordance between Paco2 and Petco2 among adults presenting to the emergency department with severe traumatic brain injury and to elucidate the patient groups who had discordance. ⋯ Severe chest trauma and hemodynamic and tissue perfusion state should be considered when attempting to monitor the hyperventilation in severe brain injury patients using Petco2.
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Traumatic intracerebral contusions carry a high rate of early progression and are associated with morbidity and mortality. Our objectives were to better characterize the prevalence of progression of traumatic contusions, risk factors, and the association with outcome. ⋯ A high proportion of intracerebral contusions evolve in size very early in the postinjury period and are associated with negative outcomes. There is still not a proven therapy for limiting the expansion although the association of an elevated international normalized ratio with expansion suggests that coagulation abnormalities must be actively corrected.
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New York State's Trauma System has been in place since 1990. At it's inception, 36 trauma centers were designated by the state. As of 2002 there were 50, with more centers applying for designation. The state designation process looks at various criteria that include volume and manpower standards. There is no review of the impact of a new center on neighboring centers. This impact can include issues of residency training, research, and the maintenance of provider skills. If provider skills deteriorate, there is a risk for increased mortality. This study examines how a new trauma center, in the Bronx, impacted a near-by trauma center. ⋯ The addition of a new trauma center in the Bronx had a negative impact on a near-by trauma center. Significant reductions in the volume of severely injured patients had a negative impact on factors not routinely measured like resident education, staff competency, and research. It is possible that these factors are at least partially responsible for the increased mortality rates seen after designation. These considerations are not routinely considered during the designation of new trauma centers and may actually adversely affect the very population it is trying to serve. As trauma systems mature, consideration of the impact the new center will have on the existing centers must be included in the designation process.
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Our previous study in a swine polytrauma model suggested that equieffective systemic pressor doses of arginine vasopressin (AVP) versus phenylephrine (PE) have differential effects on the systemic and cerebral microcirculation. The purpose of this study was to directly observe the effects of AVP versus PE on inflammatory changes evoked by tumor necrosis factor alpha (TNF) in the skeletal muscle microcirculation. ⋯ (1) AVP can attenuate TNF-evoked leukocyte infiltration, activation or permeability changes in the skeletal muscle microcirculation. (2) The mechanism is probably receptor mediated and does not entirely depend on sheer stress in venules or Starling forces in capillaries. (3) The magnitude of this anti-inflammatory effect is influenced by several conditions, including volume status, the colloid or crystalloid suffusion fluid, and is possibly specific to the antigenic stimulus (TNF vs. histamine).