J Trauma
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The Boston Emergency Medical Service system was studied to determine the effects of Advanced Life Support (ALS) prehospital trauma care compared to Basic Life Support (BLS) treatment. The severity of injury and clinical status of patients was defined and monitored using the Trauma Score (TS) described by Champion. ⋯ Furthermore, a positive change in prehospital TS was significantly related to an increased chance of long-term survival for any given severity of injury (p = 0.0002). From these data we conclude that the TS is useful for prehospital triage and that appropriate field ALS resuscitation results in more favorable outcomes following major trauma.
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Posterior sternoclavicular joint dislocations are thought to be exceedingly uncommon. Two recent cases are discussed in terms of diagnosis, management, and potential risk to the patient. ⋯ Sternal oblique X-rays and tomograms are helpful in diagnosis. This entity may be promptly recognized and treated in the emergency department with gratifying results.
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Provided herein is a summary of findings by the authors and other investigators regarding the application of evoked potential studies to the assessment of neurologic function in severely head-injured patients in the acute and subacute stages postinjury. Multimodality Evoked Potentials (MEP's) are reportedly useful in three primary areas: 1) diagnosis; 2) prognosis; and 3) monitoring recovery. In diagnosis, the abnormalities in MEP's can be associated specifically with focal sensory/motor deficits such as hemiparesis and, generally, with the severity and extent of brain dysfunction. ⋯ Their accuracy is superior to many commonly used indices and MEP results add strength to clinical indicators of prognosis. Changes in MEP results obtained within a patient over time can be used to trace recovery and assess, for an individual, the functional consequences of secondary neurologic insult or medical complication. The authors conclude that MEP studies may serve a useful function as noninvasive indices of neurologic function in the management of severely head-injured patients.
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The effect of sepsis in modifying post-surgical fuel utilization in critically ill patients was determined from 374 observations (246 septic [S] and 128 nonseptic [N] in 12 intubated ICU patients studied serially. Patients received TPN (values/24 hrs: Septic, N2, 9.1 +/- 2.2 gm; glucose, 543 +/- 211 kcal/m2, Nonseptic, N2, 8.3 +/- 3.6 gm; glucose, 550 +/- 346 kcal/m2). In some periods, intravenous lipid (L) was given to raise total caloric intake to 826 +/- 223 kcal/ 24 hr/m2. ⋯ During hypercaloric lipid infusion in septic patients (SL) VO2 and VCO2 increased but VO2 was still greater, so RQ remained low (SL RQ = 0.89). As sepsis worsened VO2 remained high but VCO2 fell producing RQ less than 0.8, while plasma glucose levels were increased. These data suggest that septic patients are more dependent than nonseptics on lipid fuels for oxidative metabolism, and that IV lipids can be used to increase oxidative metabolism in sepsis at a time when glucose metabolism appears reduced.
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Effects of nonfragmenting solid brass bullets (5.56 mm, 3.1 gm, 1.9 cm long, machine-made at Letterman Army Institute of Research) and fragmenting soft-point bullets (5.56 mm, 3.2 gm, 1.7 cm long, commercially made by Hornady Manufacturing Co., Grand Island, NE) were compared when they were fired through soft tissue of the hind legs of five live swine (50 to 70 kg). The swine were anesthetized endotracheally (0.8% halothane) and placed in the supine position with the hind legs extended. Blocks of tissue simulant (10% gelatin at 4 degrees C, molded in blocks 20 X 22 X 47 cm) were placed against the skin at the predicted point of bullet exit. ⋯ The recovered bullets were weighed. The results showed that the fragmenting bullet lost 59 to 77% of its original weight and the nonfragmenting bullet was the same weight as originally. Recognition of the amount of tissue disruption and identification of bullet fragments in the wounds resulting from the two different bullets should be a useful guide to operating surgeons in selecting the best approach for treatment of gunshot injuries.