J Trauma
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Despite current recommendations by the Brain Trauma Foundation regarding the placement of intracranial pressure (ICP) monitoring devices, advances in computed tomographic (CT) scan technology have led to the suggestion that increased ICP may be predicted by findings on admission head CT scan and that patients without such findings do not require such monitoring. A linear relationship exists between characteristics of admission head CT scan and initial ICP level, allowing for selective placement of ICP monitoring devices. ⋯ Therefore, the current Brain Trauma Foundation recommendation of ICP monitoring in those patients presenting with a GCS score < 8 with an abnormal CT scan or a normal CT scan with age > 40 years, systolic blood pressure < 90 mm Hg, or exhibiting posturing should be followed.
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Comparative Study
Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine.
Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury. ⋯ The use of zeolite hemostatic agent (1% residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.
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Ultrasound (US) is commonly used for the diagnosis of hemoperitoneum after blunt abdominal trauma, but the value of US as an aid for identification of operative lesions after penetrating trauma is not well documented. The purpose of this investigation was to determine the accuracy of US for the evaluation of penetrating torso trauma and to assess the impact of this information on patient management. ⋯ The US examination lacks sensitivity to be used alone in determining operative intervention after gunshot or stab wounds. Rarely does US information contribute to the management of patients with penetrating abdominal injuries.
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The high rate of non-union makes surgical intervention necessary for a distal clavicle fracture. This report presents the outcome of a simple surgical method using a transacrominal Knowles pin for this unstable fracture. ⋯ Single transacrominal Knowles pin fixation offers a simple and safe method for treating patients with displaced Neer type 2 distal clavicle fractures.
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Current American College of Surgeons Committee on Trauma criteria for major resuscitation include prehospital respiratory compromise or obstruction and/or intubation and mandate an attending trauma surgeon's presence on patient's arrival to the emergency department (ED). A substantial number of trauma patients arrive intubated, with no other physiologic compromise. We hypothesized that field or ED intubation in the absence of other major criteria does not require trauma surgeon presence on patient arrival. ⋯ Intubated patients with central stab wounds represent a high-risk group and should mandate trauma surgeon presence on patient arrival. Excluding stab wounds, field or ED intubation alone rarely requires emergent surgical decision-making. Therefore, field or ED intubation alone should not mandate trauma surgeon presence on patient arrival.