J Trauma
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Increased use of autotransfusion for traumatic hemorrhage may reduce amounts of banked blood needed for severe injuries. Autotransfusion is standard for traumatic hemothorax, but has been limited for abdominal injuries. This prospective study used microbiologic data from 152 patients with intestinal injuries. ⋯ No statistically significant increase was found in site-specific infection risk when severity of injury was stratified according to PATI. Bacteremias, pulmonary infections, and urinary infections were not caused by bacteria cultured from autotransfused blood. We conclude that washed CPB may be autotransfused without significantly increased risk of infection in patients with severe abdominal injuries.
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Case Reports
Radial neck fracture complicating closed reduction of a posterior elbow dislocation in a child: case report.
A case of radial neck fracture complicating repeated attempts at closed reduction of a posterior elbow dislocation in a child is described. This case underscores the necessity of using proper technique when reducing posterior elbow dislocations. The mechanism of radial neck fracture in association with posterior elbow dislocation is discussed.
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Prospective clinical studies have shown that hypotension from hemorrhage contributes to increased morbidity and mortality in patients with traumatic brain injury. It is implied that poorer outcome is the result of secondary brain injury from impaired cerebral oxygen delivery (cO2del). We studied the early and late effects of hypertonic sodium lactate (HSL: 500 mOsm/L) resuscitation on mean arterial pressure (MAP), cardiac output (CO), systemic oxygen delivery (sO2del), cerebral perfusion pressure (CPP), intracranial pressure (ICP), cO2del, cerebral blood flow (CBF), serum osmolality, and cortical water content (CWC) in a porcine model of hemorrhagic shock. ⋯ The CWC was significantly lower in the HSL-treated animals (p less than 0.05). We attribute these effects to hypertonic dehydration of both the brain parenchyma and the cerebrovascular endothelium. These data suggest that by decreasing ICP and improving cO2del after shock, HSL could decrease secondary brain injury when brain injury and shock occur together.
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Over a 32-month period, the cases of all patients with multiple injuries on whom cervical spine roentgenograms (CSRs) were obtained during blunt trauma evaluation in a trauma center were reviewed to determine the incidence, outcome, and clinical consequence of delayed diagnosis of cervical spine injuries. A total of 1,331 patients had CSRs following blunt injury. Sixty-one (4.6%) of the patients had documented cervical fractures or dislocations. ⋯ Radiologic misinterpretation occurred in one patient. The diagnosis of cervical spine injury was pursued because of persistent neck pain in two patients, and the development of subtle neurologic findings in three. The neurologic deficits in the three patients resolved.(ABSTRACT TRUNCATED AT 250 WORDS)
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The management of blunt trauma victims with indeterminate diagnostic peritoneal lavage (DPL) findings remains controversial. We reviewed 1,196 patients undergoing DPL to identify patients with indeterminate DPL (red cell counts of 20,000 to 99,999 rbc/mm3). Only 4% (48%) had indeterminate DPL results. ⋯ Only one of these patients required therapeutic intervention at the time of laparotomy. Intra-abdominal injury was common in patients with indeterminate DPL results, however, only four (8%) of the patients required a therapeutic operation. Both negative repeat DPL results or negative findings on CT scans predicted successful nonoperative management.(ABSTRACT TRUNCATED AT 250 WORDS)