J Trauma
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Comparative Study
Blunt chest trauma victims: role of intravascular ultrasound and transesophageal echocardiography in cases of abnormal thoracic aortogram.
The objective of our study was to use transesophageal echocardiography (TEE) and intravascular ultrasonography (IVUS) to evaluate their role in interrogating abnormal or equivocal findings seen on thoracic aortography performed on blunt chest trauma patients. ⋯ When thoracic aortography yields an abnormal and especially equivocal findings, both IVUS and TEE are helpful in further sorting this out rather than subjecting the patient to a potentially unnecessary thoracotomy. In cases of aortic injury suspected at the lesser curvature of the arch-isthmic junction, TEE allowed better delineation because of multiplane imaging capability.
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Comparative Study
Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma.
Concern for thoracolumbar spine (TLS) injuries after major trauma mandates immobilization pending radiographic evaluation. Current protocols use standard posteroanterior and lateral radiographs of the thoracolumbar spine (XR/TLS), but many patients also undergo abdominal or thoracic computed tomographic (CT) scanning. We sought to evaluate whether helical truncal CT scanning performed to evaluate visceral trauma images the spine as well as dedicated XR/TLS. ⋯ CT/CAP diagnoses TLS fractures more accurately than XR/TLS. Neither misses unstable fractures, but CT scanning finds small fractures that benefit by treatment and identifies chronic disease better. CT screening is far faster and shortens time to removal of spine precautions. CT scan-based diagnosis does not result in greater radiation exposure and improves resource use. Screening the TLS on truncal helical CT scanning performed for the evaluation of visceral injuries is more accurate than TLS imaging by standard radiography. CT/CAP should replace plain radiographs in high-risk trauma patients who require screening.
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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.