J Trauma
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Comparative Study
The stabilizing effects of different orthoses in the intact and unstable upper cervical spine: a cadaver study.
Although cervical orthoses are frequently used in prehospital stabilization and in the definitive treatment for lesions of the cervical spine, there is little information about the control of extension-flexion, lateral bending, and rotation given to individual segments by different designs. ⋯ The halo vest seems to be the first choice for conservative treatment of unstable injuries of the upper cervical spine, although pin track problems, accurate fitting of the vest, and a lack of patient compliance lead to clinical failures.
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For patients > 55 years, nonoperative management (NOM) of blunt splenic injury remains controversial. Conflicting reports of excessively high or acceptably low failure rates have discouraged widespread application of NOM in these older patients. However, the small number of patients in these studies limits the impact of their conclusions. ⋯ Nonoperative management of lower grade splenic injuries in patients > 55 years can be accomplished with an acceptably low failure rate. Only grade of splenic injury, not patient age, increases the risk of NOM failure.
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The radiographic diagnosis of blunt traumatic aortic laceration (BTAL) remains problematic. We reviewed our experience with chest radiographic signs of BTAL at a single trauma center. ⋯ The experience at our institution suggests that chest radiographs have limited utility in the accurate diagnosis of blunt traumatic aortic laceration. Cross-sectional imaging techniques will likely become the preferred imaging procedures for evaluating patients with suspected BTAL.
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Previous studies have reached contradictory conclusions regarding where injured children are best treated. Our hypothesis was that no differences in survival outcome exist among trauma centers caring for pediatric patients. ⋯ The improved unexpected outcome results at Level I centers and centers with Added Qualifications in Pediatrics suggest that a team of qualified professionals working in an institution willing to commit the required resources can sufficiently offer injured children the survival advantage expected of a trauma center.
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To evaluate our developed volume supplement protocol in preventing hypernatremia after head injury. ⋯ Our protocol worked effectively in patients in whom renal function was preserved. Decreased creatinine clearance because of preexisting dehydration and lower arterial pressure disturbed increase in urinary sodium excretion and temporarily aggravated the hypernatremia.