J Trauma
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Critically ill surgical patients are often difficult to assess for complications because of their altered sensorium, multiple monitoring devices, and immobility. Surgeon-performed ultrasound may enhance the physical examination of these patients and provide for an early detection of select complications. We hypothesized that a focused thoracic ultrasound examination could reliably detect a pleural effusion and the results could be used in the decision matrix for patient care. ⋯ A focused thoracic ultrasound examination reliably detects pleural effusions in critically ill patients, and the results can be used successfully in the decision matrix for patient care.
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The ability of abdominal ultrasound to detect intraperitoneal fluid in the pregnant trauma patient has been questioned. ⋯ The sensitivity and specificity of abdominal ultrasonography in pregnant trauma patients is similar to that seen in nonpregnant patients. Occasional false negatives occur and a negative initial examination should not be used as conclusive evidence that intra-abdominal injury is not present. Ultrasound has the advantages of no radiation exposure.
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The purpose of this study is to present the rationale for an algorithm that describes the place of resuscitative thoracotomy in the prehospital management of a patient with penetrating chest injury, and to review a 6-year experience using this algorithm. ⋯ Current evidence suggests that patients who suffer a cardiac arrest more than 10 minutes away from emergency room thoracotomy are very unlikely to survive. Prehospital thoracotomy is associated with a small number of survivors. This intervention should be considered if there is an appropriately experienced, trained, and equipped doctor present, who is acting within a trauma system with ongoing training and quality assurance.
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Despite the lack of evidence, traditional trauma teaching has suggested that low rib fractures increase the risk of abdominal solid organ injury (ASOI). This study was designed to assess if in fact this is true, and to try and define other factors that increased the risk of ASOI in rib fracture patients. ⋯ In hospitalized trauma patients, low rib fractures, right-sided rib fractures, female gender, young age, and an elevated ISS increased the probability of liver injury; and low rib fractures, left-sided only rib fractures, young age, and an elevated ISS increased the probability of splenic injury. Associated pelvic fractures and long bone fractures did not increase the likelihood of ASOI in this cohort.