J Trauma
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Comparative Study
Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury.
The role of helicopter transport (HT) in civilian trauma care remains controversial. The objective of this study was to compare patient outcomes after transport from the scene of injury by HT and ground transport using a national patient sample. ⋯ Trauma patients transported by helicopter were more severely injured, had longer transport times, and required more hospital resources than those transported by ground. Despite this, HT patients were more likely to survive and were more likely to be discharged home after treatment when compared with those transported by ground. Despite concerns regarding helicopter utilization in the civilian setting, this study shows that HT has merit and impacts outcome.
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Comparative Study
The pattern of thoracic trauma after suicide terrorist bombing attacks.
The worldwide escalation in the volume of suicide terrorist bombing attacks warrants special attention to the specific pattern of injury associated with such attacks. The goal of this study was to characterize thoracic injuries inflicted by terrorist-related explosions and compare pattern of injury to penetrating and blunt thoracic trauma. ⋯ Injury inflicted by terrorist bombings causes a unique pattern of thoracic wounds. Victims are exposed to a combination of lung injury caused by the blast wave and penetrating injury caused by metallic objects.
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Randomized Controlled Trial Comparative Study
Proper estimation of blood loss on scene of trauma: tool or tale?
Visually estimated amount of blood loss may influence decision making in the prehospital setting. The purpose of this study was to determine the ability and accuracy of paramedics and emergency physicians to visually estimate a volume of external blood loss and the influence of different vital signs. ⋯ With regard to all given amounts of blood loss, providing vital parameters suggesting instability (i.e., low blood pressure, high heart rate) led to a higher estimation of the lost blood volume in both paramedics and emergency physicians. However, estimations were influenced impressively by the given parameters. For both stable and unstable patients, small actual volumes were overestimated, whereas higher volumes tended to be underestimated. Neither occupational status (emergency physician or paramedic) nor gender or level of experience influenced accuracy of estimated blood loss significantly.
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Reported iatrogenic injury to the proximal femoral vascular structures is rare after retrograde femoral nailing. Previous cadaveric dissections have recommended placement of proximal interlocking screws above the level of the lesser trochanter. ⋯ No true safe zone corridor exists anteriorly for placement of AP interlocking screws in this region. Surgical technique modifications are suggested to minimize the potential risks of iatrogenic arterial injury during retrograde femoral nail AP proximal interlocking.
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Shock index (SI) is recognized to be a more reliable early indicator of hemorrhage than traditional vital signs. Acute traumatic brain injury (TBI) can be associated with autonomic uncoupling and may therefore alter the reliability of SI in patients with combined TBI and peripheral hemorrhage. The aim of this study was to evaluate the performance of SI when acute TBI of mild and moderate severity were associated with progressive simple hemorrhage. ⋯ SI significantly underestimated underlying hemorrhage in the presence of acute TBI of moderate severity where attenuation of the biphasic heart rate and blood pressure response was also most pronounced.