J Trauma
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Comparative Study
When should a chest radiograph be obtained after chest tube removal in mechanically ventilated patients? A prospective study.
The purpose of this study was to determine the appropriate time interval between the removal of a chest tube and the chest radiograph (CXR). We hypothesized that a CXR obtained 1 hour after chest tube removal would exclude the presence of a recurrent pneumothorax. ⋯ A CXR obtained within 1 to 3 hours after chest tube removal effectively identifies pneumothorax in mechanically ventilated patients.
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Comparative Study
Family impact greatest: predictors of quality of life and psychological adjustment in pediatric burn survivors.
Although there is some knowledge of psychological adjustment, almost nothing is known about quality of life in pediatric burn survivors. ⋯ If given optimal care, most pediatric burn survivors demonstrate excellent quality of life. Families with compromised relationships and patients with higher age at burn injury should be identified early, monitored closely, and offered psychosocial support as soon as dysfunctional family dynamics are detected.
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Comparative Study
Release of abdominal compartment syndrome improves survival in patients with burn injury.
Abdominal compartment syndrome (ACS) has rarely been described as a complication of burn injury. This study describes cases of ACS in patients with burn injury and the physiologic results of abdominal release. ⋯ Abdominal release for patients with ACS and severe burn injury results in physiologic improvement and a 40% survival rate. We recommend bladder pressure monitoring for all patients with severe burn injuries and abdominal decompression in any patient who develops pressures greater than 30 mm Hg if they have signs of physiologic compromise. Aggressive expectant management can effect a 40% survival rate in this group of severely injured patients.
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Although there are nearly a quarter of a million hospitalizations for traumatic brain injury (TBI) in the United States each year, data on the outcomes and costs of TBI treatment in the acute-care setting are limited. ⋯ The economic burden of TBI in the acute-care setting is substantial; treatment outcomes and costs vary considerably by TBI severity and mechanism of injury.