J Trauma
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Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no satisfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. ⋯ Prehospital blood transfusion is justified in certain trauma patients, especially when long prehospital transport is required. Blood may be safely maintained and used by physicians with little experience in care of major trauma.
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To meet American College of Surgeons criteria, Level I and II trauma centers are required to have in-house operating room (OR) staff 24 hours per day. According to the number of emergency cases occurring, hospitals may have varying needs for OR staffing during the night shift. Queueing theory, the analysis of historic data to provide optimal service while minimizing waiting, is an objective method of determining staffing needs during any time period. This study was done to determine the need to activate a backup OR team during the night shift at a designated, verified Level II trauma center. ⋯ In our institution, activation of a second OR team is unnecessary when the first team is busy with a case on the night shift because the likelihood of two cases occurring concurrently is less than one in a thousand. Queueing theory can be a valuable tool to use in determining the staffing needs of many hospital departments. Trauma centers should apply this mathematical model in optimizing the use of their operational resource.
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To define those physiologic and clinical variables that have a positive or negative predictive value in discriminating survivors from nonsurvivors with traumatic injuries and a Trauma Score of 5 or less. ⋯ In patients who survived to discharge, signs of central nervous system activity in the field was a positive predictor of survival, and severe head injury served as a negative predictor of survival.
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The rate and magnitude of pH changes in the bowel during hemorrhagic shock are greater than those in the stomach, implying that gastric intramucosal pH may not be a reliable indicator of gut perfusion. Here, we evaluate near-infrared spectroscopy (NIRS) to assess bowel pH in a swine shock model. ⋯ NIRS determination of small-bowel pH may be a good tool to monitor the adequacy of resuscitation.
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The early removal of large residual posttraumatic hemothorax by videothoracoscopy is increasingly used to avoid the late sequelae of trapped lung and empyema. Plain chest radiography (CXR) is the tool most frequently used to select such cases for operation. Our recent experience has demonstrated that what appears to be a large retained hemothorax on CXR may turn out to be intrapulmonary or extrapleural conditions not amenable to thoracoscopic removal. Our objective was to evaluate the accuracy of CXR in detecting significant residual hemothorax and compare its clinical value to thoracic computed tomography (CT) when used to select patients for thoracoscopic evacuation. ⋯ Although CXR is useful as a screening tool, it cannot be used to reliably select patients for surgical evacuation of retained traumatic hemothorax. Decision-making should be based on thoracic CT findings.