J Trauma
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Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation. ⋯ In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.
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Fear of the adverse effects of hypoglycemia has limited the widespread application of intensive insulin therapy (goal, 80-110 mg/dL) in the trauma population. We hypothesized that severe hypoglycemia (SH;
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Major pelvic trauma results in high mortality. No standard technique to control pelvic hemorrhage has been identified. ⋯ Application of a clinical algorithm focusing on basic radiologic diagnostics, external fixation, and early angiographic embolization was effective and safe to rapidly control hemorrhage in hemodynamically instable trauma patients with pelvic fractures.
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Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficult and risks articular penetration. Spring plates are used to avoid articular penetration. Both lag screws and spring plates are usually buttressed by reconstruction plates. ⋯ The marginal fracture is fixed using monocortical locking head screws. This technique has been performed on three patients; none had secondary displacement or nonunion. Fixing marginal posterior acetabular wall fractures using locking reconstruction plates and monocortical screws saves additional lag screws or spring plates without risking articular penetration.
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Injury Severity Score (ISS) is commonly used in prediction models and risk adjustment for mortality. However, few studies have assessed the relationship of ISS to outcomes such as resource use. To test the utility of ISS for investigation of the quality of trauma care, we evaluated the impact of ISS on resource utilization and mortality. ⋯ Specific ISS and injured organs may be used to estimate resource use or mortality for monitoring quality of trauma care. To integrate a more efficient system of trauma care, variations in resource input among hospitals should be investigated.