J Trauma
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Hemorrhagic shock and resuscitation (HSR) induces pulmonary inflammation that leads to acute lung injury. Carbon monoxide (CO), a by-product of heme catalysis, was shown to have potent cytoprotective and anti-inflammatory effects. The aim of this study was to examine the effects of CO inhalation at low concentration on lung injury induced by HSR in rats. ⋯ These findings suggest that inhaled CO at a low concentration ameliorated HSR-induced lung injury and attenuated inflammatory cascades by up-regulation of anti-inflammatory IL-10.
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The Trauma Quality Improvement Project has demonstrated significant variations in risk-adjusted mortality rates across the designated trauma centers. It is not known whether the outcome differences are related to provider-level clinical decision making. We hypothesized that centers with good outcomes undertake critical operative interventions aggressively, thereby avoiding complications and deaths. ⋯ Trauma centers with higher risk-adjusted mortality rates are more likely to undertake operative interventions for solid organ injuries. Hence, there is a need to focus quality improvement efforts on medical decision-making and perioperative processes of care.
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Elderly trauma patients have a higher incidence of medical comorbidities when compared with their younger cohorts. Currently, the minimally accepted criteria established by the Committee on Trauma for the highest level of trauma activation (Level I) does not include age as a factor. Should patients older than 60 years with multiple injuries and/or a significant mechanism of injury be considered as part of the criteria for Level I activation? Would these patients benefit from a higher level of activation? ⋯ Patients with an ISS between 0 and 15 are often triaged to Level II activation. Our data would suggest that patients older than 60 years should be a criterion for the highest level of trauma activation.
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Plate fixation is frequently used to repair clavicle fractures, but over drilling can cause subclavian neurovascular bundle damage. The aims of this study were to investigate the anatomic relationship between the clavicle and subclavian neurovascular bundle and to determine safe drilling angles and depths. ⋯ We have used magnetic resonance imaging to determine safe drilling directions and depth for plate-screw fixation of the clavicle. On confirmation, these findings could be used in the clinical setting to reduce the risk of inadvertent iatrogenic subclavian neurovascular bundle injury during surgical clavicle fracture repair.
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Comparative Study
Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties: in silico validation of the rule of 10.
In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the "rule of 10" to derive the initial fluid rate. ⋯ For the majority of adult burn patients, the rule of 10 approximates the initial fluid rate within acceptable ranges.