J Trauma
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Hypertonic saline/dextran (HSD) fluid resuscitation has been demonstrated to be effective in alleviating the adverse effects of hemorrhagic hypotension. The optimal dose of HSD has not been defined. ⋯ In terms of survival time, the 11.5- and 4-mL/kg doses were not significantly different. Therefore, optimum resuscitative effectiveness of HSD is achieved within the dose range of 4 to 11.5 mL/kg.
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Historical Article
From Anthony Henday to big box superstores: trends in Canadian trauma care.
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Lung protective ventilatory strategies using low tidal volume and high positive end-expiratory pressure (PEEP) have become standard practice. Such strategies, however, may invalidate measurement of lung injury severity by traditional methods that are based on plain chest radiograph findings, oxygenation, minute ventilation, lung compliance, and PEEP level, such as the Murray lung injury score (LIS). Many of these criteria are potentially therapy dependent and may change with different ventilatory strategies. The purpose of this study was to determine whether measurement of lung injury severity based simply on oxygenation criteria (PaO(2)/FIO(2)) was as accurate as the Murray LIS currently used in multiple organ failure (MOF) scoring. ⋯ The P/F score is a simple method of quantifying lung injury severity in trauma patients that better predicts mortality compared with the more complicated modified Murray lung injury score currently in use. The P/F score should replace more complex and potentially therapy-dependent scores.
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Little data are available regarding the impact that prolonged prophylactic antibiotic use (>48 hours) has on the development of nosocomial pneumonia. This retrospective study was conducted to assess the effect that prolonged prophylactic antibiotic use has on the development of nosocomial pneumonia and antibiotic use complications. ⋯ Justification for the use and duration of prolonged (>48 hours) prophylactic antibiotics requires careful reevaluation because this practice is associated with significant clinical complications that lead to increased use of patient resources, lengthened hospital stay, and higher cost.