J Trauma
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Emergent endotracheal intubation (ETI) is considered the standard of care for patients with severe traumatic brain injury (TBI). However, recent evidence suggests that the procedure may be associated with increased mortality, possibly reflecting inadequate training, suboptimal patient selection, or inappropriate ventilation. ⋯ Prehospital intubation seems to improve outcomes in more critically injured TBI patients. Air medical outcomes are better than predicted for both intubated and nonintubated TBI patients. Iatrogenic hyper- and hypoventilations are associated with worse outcomes.
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Comparative Study
Reducing leukocyte trafficking preserves hepatic function after sepsis.
Leukocyte trafficking may induce hepatic dysfunction in sepsis. Herein, we hypothesize that reduction in leukocyte adhesion and, hence, leukocyte-endothelial interaction by activated protein C (aPC) may preserve hepatic function after sepsis. ⋯ Our data demonstrate that sepsis may, in part, induce hepatic dysfunction by augmenting leukocyte trafficking into hepatic sinusoids. Treatment with aPC attenuated leukocyte trafficking and, in doing so, preserved hepatic function and improved survival. Collectively, these data suggest an important role for protein C-dependent leukocyte-endothelial interaction in sepsis.
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The impact of implementing an inclusive state trauma system on injury-related mortality for patients with life-threatening injuries was assessed. ⋯ Since its inception, Delaware's trauma system, in which all acute care hospitals participate, has been associated with an incremental, significant decrease in mortality of the most critically injured patients. This decrease is more substantial than that experienced nationally as depicted within the NTDB. These findings and our evolving experience support the concept and benefits of an "inclusive" trauma system.
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The ability to reliably include a skin paddle with the fibula osteoseptocutaneous (OSC) flap is crucial both from the perspective soft tissue reconstruction and flap monitoring. In this study, we describe a three-step approach to the harvest of the fibula OSC flap that is reliable and versatile. ⋯ The three-step approach allowed us to reliably harvest the fibula OSC flap. We were able to visualize the anatomy clearly with this technique, and this has enabled us to detect anomalous anatomy early on in the dissection. These were successfully managed by using musculocutaneous perforators to the skin island that would normally be cut.