J Trauma
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Continuous arteriovenous rewarming (CAVR) has been shown to effectively reverse hypothermia; however, its use is limited in the setting of profound hypotension. We have evaluated the effectiveness of high-flow venovenous rewarming (HFVR) using bypass for the correction of hypothermia in a hypotensive canine model and compared these results to CAVR. ⋯ HFVR is an effective method for rapid rewarming in a profoundly hypothermic, hypotensive animal model and may have clinical utility in patients presenting with hypovolemia/hypotension complicated by hypothermia.
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Multicenter Study
Multicenter prospective validation of prehospital clinical spinal clearance criteria.
Spine immobilization is one of the most frequently performed prehospital procedures. If trauma patients without significant risk for spine injury complications can be identified, spine immobilization could be selectively performed. The purpose of this study was to evaluate five prehospital clinical criteria-altered mental status, neurologic deficit, spine pain or tenderness, evidence of intoxication, or suspected extremity fracture-the absence of which identify prehospital trauma patients without a significant spine injury. ⋯ Absence of the study criteria may form the basis of a prehospital protocol that could be used to identify trauma patients who may safely have rigid spine immobilization withheld. Evaluation of such a protocol in practice should be performed.
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The purpose of this study was to compare the abilities of nine Abbreviated Injury Scale (AIS)- and (ICD-9)-based scoring algorithms in predicting mortality. ⋯ Differences in performance were relatively small. Complex scores such as the ICISS and the APS provide improvement in discrimination relative to the maxAIS and the ISS. Trauma registries should move to include the ICISS and the APS. The ISS and maxAIS perform moderately well and have bedside benefits.
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The purpose of this study was to determine whether end-tidal carbon dioxide (PETCO) derived variables assist in evaluating the adequacy of resuscitation during emergency surgery for trauma. ⋯ During emergency trauma surgery, the PETCO and its derived values help to predict outcome and may be used to identify patients needing more aggressive resuscitation.