J Trauma
-
Selective nonoperative management (NOM) of blunt splenic injuries is becoming a more prevalent practice. Inclusion criteria for NOM, which have been a source of controversy, continue to evolve. Age > or = 55 years has been proposed as a predictor for failure of and even a contraindication to NOM of blunt splenic trauma. Additionally, the high rate of NOM in children (up to 79%) has been attributed to their management by pediatric surgeons. We evaluated our experience with NOM of blunt splenic injury with special attention to these age groups. ⋯ Age > or = 55 years is not a contraindication to nonoperative management of blunt splenic injuries. Children with blunt splenic injuries can be successfully managed nonoperatively by nonpediatric trauma surgeons.
-
The geographic distribution of trauma centers results in a significant number of children being treated in adult centers. The emphasis on nonoperative management of pediatric blunt trauma has heightened concern that in adult trauma centers, an aggressive operative approach will continue to be used. We hypothesized that pediatric commitment at a Level I trauma center results in appropriate nonoperative care of injured children as established by regional pediatric trauma centers. ⋯ There has been a declining trend in the operative management of blunt pediatric trauma, especially in children less than 6 years old, whereas the operative management of penetrating injuries has remained stable. These data confirm that pediatric commitment in a Level I trauma center results in nonoperative treatment of injured children commensurate with that established in regional pediatric trauma centers.
-
Clinical Trial Controlled Clinical Trial
Difference in the responses after administration of granulocyte colony-stimulating factor in septic patients with relative neutropenia.
The objective of this study was to classify the clinical responses after administration of granulocyte colony-stimulating factor (G-CSF) in septic patients with relative neutropenia. ⋯ G-CSF administration was effective in septic patients with a low percentage of immature neutrophils and insufficient endogenous G-CSF. It had little effect on patients with a high percentage of immature neutrophils whose G-CSF production was up-regulated and whose bone marrow was severely depressed.
-
To compare accelerational forces to the head in high school-level football, hockey, and soccer athletes. ⋯ Peak accelerations as measured at the surface of the head were 160 to 180% greater from heading a soccer ball than from routine (noninjurious) impacts during hockey or football, respectively. The effect of cumulative impacts at this level may lead to neurologic sequelae.
-
Comparative Study
Prehospital resuscitation with phenylephrine in uncontrolled hemorrhagic shock and brain injury.
Hypotension doubles the adverse outcome of severe brain injury (BI). This finding is thought to be due to secondary ischemia caused by cerebral hypoperfusion. Aggressive prehospital fluid resuscitation in BI is advocated to maintain mean arterial pressure (MAP). Increasing MAP by prehospital fluid resuscitation before control of hemorrhage is thought to increase blood loss and reduce survival. We hypothesized that vasoconstrictor treatment of uncontrolled hemorrhage would increase MAP, reduce hemorrhage volume, and decrease the extent of BI compared with delayed fluid resuscitation (DR) or resuscitation with Ringer's lactate (RL). ⋯ Phen improves MAP and systemic and cerebral perfusion pressure in the prehospital phase but does not reduce secondary neuronal ischemia. RL restores cerebral blood flow earlier and is associated with less secondary ischemia than either Phen or DR in this model. These data suggest that prehospital infusion of RL in patients with BI and shock is warranted and decreases secondary ischemia.