J Trauma
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Comparative Study
Lateral gastrocnemius flap cover for distal thigh soft tissue loss.
The gastrocnemius muscle flap has been used extensively for cover around the knee. However, the use of the lateral gastrocnemius for cover of the distal thigh has not been well described. ⋯ The lateral gastrocnemius muscle flap is effective in the cover of the lateral distal thigh.
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Comparative Study
Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock.
Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone. ⋯ Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.
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Comparative Study
Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients.
Ventilator-associated pneumonia (VAP) incidence is used as a quality measure. We hypothesized that patient and provider factors accounted for the higher incidence of VAP in trauma patients compared with other critically ill patients. ⋯ The incidence of VAP is greatest among trauma patients at our institution. The increased use of bronchoalveolar lavage, the earlier onset of VAP, and the higher incidence of gram-negative pneumonias suggest that both patient and provider factors may influence this phenomenon. VAP was associated with increased mortality in the nontrauma group only. These factors should be considered before VAP is applied as a quality indicator.
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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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Multicenter Study Comparative Study
Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy.
This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. ⋯ Patients whose first SI was ≥ 0.8 and second SI ≥ 1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI < 0.8 and base deficits ≥ -1.0 will not be candidates for the B group.