J Trauma
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Inhalation injury complicated by bacterial pneumonia is now one of the primary causes of morbidity and mortality in patients with thermal injury. We have investigated the use of high-frequency percussive ventilation (HFPV) as a means of ventilatory support for these patients. We propose that high-frequency ventilation may decrease the incidence of pulmonary infection following inhalation injury and decrease the incidence of iatrogenic barotrauma caused by conventional ventilation. ⋯ Eight patients with a mean age of 29 years and a mean burn size of 38% of the total body surface completed the protocol. All patients survived, two developed pneumonia, and one developed subcutaneous emphysema. These results suggest that HFPV is effective in the treatment of patients with severe inhalation injury.
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Comparative Study
Non-cavitary hemorrhage producing shock in trauma patients: incidence and severity.
Intraperitoneal and intrathoracic bleeding, cavitary hemorrhage (CH), are recognized as major causes of hypovolemic shock in trauma patients. Blood loss from fractures and lacerations, non-cavitary hemorrhage (NCH), is not considered a common cause of shock. ⋯ There was no significant difference in the resuscitative fluid requirements, morbidity, or mortality between patients presenting in hypovolemic shock due to CH and NCH. Blood loss from NCH must be recognized as a significant source of hypovolemic shock in trauma patients.
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Significant differences were identified between a group of elderly patients (65 years and older) and a nonelderly group both with blunt thoracic trauma. There was a lower incidence of elderly patients presenting in shock; however, cardiopulmonary arrest at arrival was more frequent in this group. ⋯ A high index of suspicion must be generated for an elderly patient who has sustained blunt chest trauma. An aggressive diagnostic and therapeutic approach may lead to a decrease in the high morbidity and mortality rates in the elderly.