J Trauma
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An unusual indication--not previously reported--for surgical treatment of a clavicle fracture, in a 56-year-old male, is presented. The proximal fragment had been entrapped under the coracoid, and there were symptoms from impairment of the musculocutaneous nerve. Reduction by closed means proved unsuccessful, and an open procedure was necessary for this rare type of the common clavicle fracture.
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(1) To independently validate the Trauma and Injury Severity Score-Like (TRISS-Like) model derived by Offner et al. (Revision of TRISS for intubated patients. J Trauma. 1992;32:32-35) in a population of Canadian blunt trauma victims, and (2) to compare the ability of this model to predict mortality in early and late trauma deaths. ⋯ TRISS-Like demonstrated similar performance to that reported with the standard TRISS model but with the additional advantage that it is more generalizable because it can be applied to intubated patients. TRISS-Like demonstrated substantially superior performance in early trauma deaths compared with those that occurred late. This differential performance may be because the model does not include risk factors for late mortality.
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Not all field triage patients need full trauma team activation. Secondary emergency department (ED) triage (supertriage), a clinical and anatomic screen, determines trauma team versus ED management. The purpose was to study the effects of supertriage on injury severity and disposition by patients managed with and without team activation. ⋯ Supertriage identified a majority requiring team activation; however, resources must be available for the seriously injured not meeting field or hospital triage criteria.
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Pulmonary gas exchange in correlation with condensed lung volume was prospectively studied in 10 patients with multiple injuries and blunt chest trauma. The purpose was to find nomograms that allow the estimation of the extent of pulmonary density from gas exchange parameters. The condensed lung volume was determined planimetrically from serial transverse sections of chest computed tomographic scans. ⋯ By using linear regression equations (linear regression line with 95% confidence interval), nomograms were calculated. The extent of pulmonary density can easily be obtained from these nomograms by measuring Qs/Qt or P(A-a)O2. The presented nomograms may be helpful in monitoring the effect of treatment in patients with blunt chest trauma.