J Trauma
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Prone ventilation improves oxygenation in selected patients with acute respiratory distress syndrome (ARDS). However, prone positioning of critically ill patients with multiple invasive lines and tubes is potentially dangerous. Trauma patients, in particular, may require special consideration because of skeletal fixation devices or prior operative procedures. Our objective was to critically evaluate our experience with prone positioning in patients with severe postinjury ARDS. ⋯ Prone ventilation in postinjury patients with ARDS may improve oxygenation but has the potential for significant complications. Careful consideration is required before prone positioning in this subset of patients.
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To examine a subgroup of severely injured patients spending > or = 3 weeks in the intensive care unit (ICU) and to determine their disposition and eventual functional outcome. ⋯ Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays can eventually return to varying degrees of functional daily living and independence, but not to preinjury levels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However, elderly survivors that entered our rehabilitation facility fared as well as the younger patients.
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The submental route for endotracheal intubation has been proposed as an alternative to tracheotomy in the surgical management of patients with maxillofacial trauma. The purpose of this study was to review our experience with this procedure. ⋯ Submental intubation is a simple technique associated with a low morbidity. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.
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We present a retrospective analysis of a case series to evaluate closed intramedullary Kirschner wire (K-wire) fixation as a surgical technique in the treatment of femoral shaft fractures in children. ⋯ Closed intramedullary K-wire fixation for femoral shaft fractures in children is a simple surgical technique that has excellent clinical and functional results.
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The potential need for rapid medical intervention and access to a trauma center after major injury is crucial to the safety and success of SWAT team operations. This manuscript describes the genesis and development of a unique model for which advanced medical care is rendered by trained health care professionals within a regional trauma system in the support of a SWAT team. The model was developed jointly by the Newark, New Jersey, Division of the Federal Bureau of Investigation and The New Jersey Trauma Center-University Hospital, an academic, urban Level I trauma center. ⋯ Since inception, the medical team has provided medical support for 33 tactical missions and 99 training days. Ten patients were treated: 7 agents (syncope, fractured foot, blunt head/neck trauma, lacerations), 2 bystanders (chest pain, asthma), and 1 suspect (chest pain). The advantages of the Newark model in contrast to other programs of tactical medical support, are the operational activities of the team and the cost of the program was outlined.