J Trauma
-
Spinal injury in pediatric trauma is associated with significant morbidity and mortality, but no current consensus exists on the safest and most effective method of clearance in the high-risk pediatric trauma patient. ⋯ There is a need for an evidence-based protocol for the clearance of the spine in the obtunded and high-risk pediatric trauma patient. High-resolution CT with sagittal and coronal reconstructions should be the basis for cervical spinal clearance, in combination with the interpretation of films by an expert radiologist. All spinal regions should be imaged, and clearance should be formally documented. The role of magnetic resonance imaging in routine clearance remains controversial. Multicenter prospective studies are needed to develop consensus for an evidenced-based protocol for clearance in this high-risk group.
-
Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. To test the relative efficacy of different formulations in bleeding control, recently manufactured products need to be compared using a severe injury model. ⋯ Celox, QuikClot ACS, WoundStat, and X-Sponge ranked superior in terms of low incidence of rebleeding, volume of blood loss, maintenance of mean arterial pressure >40 mm Hg, and survival.
-
By using current American College of Surgeons trauma center triage criteria, 52% of patients transported to our level I trauma center are discharged home from the emergency department (ED). Because the majority of our trauma transports were based solely on mechanism of injury, we instituted, in 1990, a two-tiered trauma team activation system. Patients are triaged into major and minor trauma alert categories based on prehospital provider information. For minor trauma patients, respiratory therapy, operating room staff, and blood bank do not respond. The current study evaluated this triage system. ⋯ A two-tiered trauma activation system identifies patients who require a full trauma team response and may result in a more effective use of trauma center resources.
-
Prehospital spinal immobilization (PHSI) is routinely applied to patients sustaining torso gunshot wounds (GSW). Our objective was to evaluate the potential benefit of PHSI after torso GSW versus the potential to interfere with other critical aspects of care. ⋯ Our data suggest that the benefit of PHSI in patients with torso GSW remains unproven, despite a potential to interfere with emergent care in this patient population. Large prospective studies are needed to clarify the role of PHSI after torso GSW.
-
Airway compromise secondary to isolated injury at the atlas (C1) and axis (C2) without an associated spinal cord injury is a rare, but recognized phenomenon that results in significant morbidity and mortality. No previous study in the literature has reported the incidence of this potentially lethal complication of these relatively common fractures. ⋯ Approximately 5% of patients with isolated C1 and C2 fractures developed airway compromise. All patients with these injuries should be assessed for the risk of developing this complication and some will require close monitoring to detect this problem at an early stage.