J Trauma
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Comparative Study
Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties: in silico validation of the rule of 10.
In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the "rule of 10" to derive the initial fluid rate. ⋯ For the majority of adult burn patients, the rule of 10 approximates the initial fluid rate within acceptable ranges.
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The objective of this study is to compare locking and nonlocking single and dual plating constructs in maintaining posteromedial fragment reduction in a bicondylar tibial plateau fracture model. We hypothesized that posteromedial fragment fixation with medial and lateral nonlocked constructs would tolerate higher loads than with lateral locked constructs alone. ⋯ The posteromedial fragment tolerated higher loads with the CP + 1/3 tubular plate construct. The superiority of this construct may be caused by unreliable penetration of this fragment by the lateral locking screws.
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Comparative Study
Methicillin-resistant Staphylococcus aureus in wound cultures recovered from a combat support hospital in Iraq.
Staphylococcus aureus infections complicate care of combat-related injuries and can independently result in skin and soft-tissue infections during deployments or training. Community-associated methicillin-resistant S. aureus (CA-MRSA) strains seem to produce severe disease but retain susceptibility to many oral antimicrobials. This study characterizes 84 MRSA isolates recovered from wound cultures at a combat support hospital in Iraq. ⋯ This study is the first genotypic and phenotypic characterization of CA-MRSA recovered from wound cultures in a deployed combat hospital. The pattern noted was similar to that seen in soldiers stationed in the United States.
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Hollow viscus injuries (HVI) are uncommon after blunt trauma, and accomplishing a timely diagnosis can be difficult. Time to operative intervention has been implicated as a risk factor for mortality, but reports are conflicting. ⋯ HVI occurred in less than 1% of all blunt trauma admissions. Delays in operative intervention are associated with an increased mortality. A high index of suspicion is needed to make a timely diagnosis and minimize risk.
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Multicenter Study Comparative Study
Comparison of abdominal damage control surgery in combat versus civilian trauma.
The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings. ⋯ Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.