J Trauma
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The purpose of this study was to prospectively examine the accuracy of contrast-enhanced spiral thoracic computed tomography (CEST-CT) for direct detection of traumatic aortic injury resulting from blunt thoracic trauma. ⋯ CEST-CT is a valuable ancillary study for the detection of traumatic aortic injury. Spiral computed tomography is accurate for the detection and localization of both hemomediastinum and direct signs of aortic injury.
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Comparative Study
Intracranial pressure monitor placement by midlevel practitioners.
The timely treatment of patients with head injuries is affected by the availability and commitment of neurosurgeons. Use of midlevel practitioners (MLPs) may permit more efficient neurosurgical coverage. Intracranial pressure monitoring is among the most frequently used neurosurgical procedures. The purpose of this study was to examine the placement of intracranial pressure (ICP) monitors by MLPs. ⋯ ICP monitor placement by MLPs is safe. Use of MLPs may aid neurosurgeons in providing prompt monitoring of patients with head injuries.
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New Food and Drug Administration guidelines allow research to be done under an "exception to informed consent." These guidelines mandate advance public disclosure (PD) but provide no specifics for how to accomplish this task. This report outlines the history of informed consent in emergency care situations, highlights the Food and Drug Administration regulations for an exception to informed consent, and describes a stepwise approach with specific details of a PD program for a study using a blood substitute. This descriptive report can serve as a guideline for subsequent emergency care investigators in the development of a strategic plan for PD.
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Comparative Study
Lactated ringer's is superior to normal saline in a model of massive hemorrhage and resuscitation.
Previous models comparing normal saline (NS) with lactated Ringer's solution (LR) for resuscitation use only mild or moderate hemorrhage and do not address the clinical situation of massive hemorrhage and resuscitation (MHR). This work compares NS and LR by using a new rat model of MHR. ⋯ With moderate hemorrhage, NS and LR are equivalent, but in the setting of massive hemorrhage and resuscitation, significantly more physiologic derangement and mortality occurs with NS than LR. LR is superior to NS for use in massive resuscitation.