J Trauma
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Previous studies have reported low conviction rates for drunk drivers injured in motor vehicle crashes and transported to the hospital. The purpose of this study was to evaluate this rate during a recent period and to investigate the variables that predict alcohol-related convictions for injured drunk drivers admitted to our hospital. ⋯ Although this study shows an important increase in alcohol-related conviction rates, responsibility for further progress will depend on the medical community, law enforcement agencies, and the judicial system working together.
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Traumatic rupture of the thoracic aorta is recognized as a common cause of occupant death after rapid deceleration in motor vehicle collisions. The incidence of thoracic aorta rupture in pedestrian victims of vehicular collisions, however, is unknown. This study focuses on the epidemiology of injury to the thoracic aorta in pedestrian vehicular collisions. ⋯ The incidence of thoracic aortic injury in pedestrian fatalities of 12.7% is comparable with previous reports of motor vehicle collision fatalities. Because of the presence of increased associated injuries, pedestrians have a significantly higher mortality. Severely injured pedestrians are at a similar risk to motor vehicle occupants for a life-threatening injury of the thoracic aorta.
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Operative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-through lung injuries that did not involve hilar vessels or airways. Pulmonary tractotomy has evolved into use as an abbreviated thoracotomy technique in patients with severe thoracic or multivisceral trauma. As with any operative technique in high-risk patients, specific procedure-related complications may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy. ⋯ Pulmonary tractotomy is a simple and effective technique in injured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as definitive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.
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This study investigates whether factors that determine myocardial performance (preload, afterload, heart rate, and contractility) are altered after isolated unilateral pulmonary contusion. ⋯ After right-side pulmonary contusion, the most often used estimate of cardiac preload (pulmonary capillary wedge pressure) does not accurately estimate LVEDP, probably because of changes in the pulmonary circulation or mechanics. Central venous pressure is a better estimate of filling pressure, at least in these conditions, probably because it is not directly influenced by the pulmonary dysfunction. Also, ventricular performance can be impaired by depressed myocardial contractility and increased right ventricular afterload even with normal left ventricular afterload and preload. It is thus conceivable that occult myocardial dysfunction after pulmonary contusion could have a role in the progression to cardiorespiratory failure even without direct cardiac contusion.