J Trauma
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Randomized Controlled Trial Comparative Study
Removing a patient from the spine board: is the lift and slide safer than the log roll?
After spine board immobilization of the trauma victim and transport to the hospital, the patient is removed from the spine board as soon as practical. Current Advanced Trauma Life Support's recommendations are to log roll the patient 90 degrees, remove the spine board, inspect and palpate the back, and then log roll back to supine position. There are several publications showing unacceptable motion in an unstable spine when log rolling. ⋯ Spine boards can be removed using a lift-and-slide maneuver with less motion and potentially less risk to the patient's long-term neurologic function than expected using the log roll.
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Comparative Study
The relationship between INR and development of hemorrhage with placement of ventriculostomy.
This study seeks to evaluate the relationship between the risk of symptomatic hemorrhage from ventriculostomy placement and International Normalized Ratio (INR) in patients who received a ventriculostomy after traumatic brain injury. ⋯ In this retrospective study, INRs between 1.2 and 1.6 appeared to be acceptable for a neurosurgeon to place an emergent ventriculostomy in a patient with traumatic brain injury.
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Historically, minimally to moderately displaced clavicular fractures have been managed nonoperatively. However, there is no clear evidence on whether clavicular fractures can progressively displace following injury and whether such displacement might influence decisions for surgery. ⋯ We have demonstrated that a significant proportion of clavicle fractures (27% of our operative cases over a 5-year period) are minimally displaced at presentation, but are unstable and demonstrate progressive deformity during the first few weeks after injury. Because of this experience, we recommend close monitoring of nonoperatively managed clavicular fractures in the early postinjury period. A prudent policy is to obtain serial radiographic evaluation for 3 weeks, even for initially, minimally displaced clavicle fractures.