J Trauma
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To compare differences in response times, scene times, and transport times by advanced life-support-trained paramedics to trauma incidents in urban and rural locations. ⋯ Response and transport times among professional, advanced life-support-trained paramedics responding to major trauma incidents are longer in rural areas, compared with urban areas.
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Trauma has a high rate of recurrence, suggesting that some people are more injury-prone than others. This study was performed to evaluate some of the psychological and social factors that might influence the likelihood of traumatic injury. ⋯ Victims of trauma, both nonintentional, and especially intentional, have a high incidence of psychopathology. Victims of intentional trauma have significantly lower intelligence scores than either nonintentional injury or elective surgery patients. The high incidence of unemployment, alcohol abuse, and illicit drug use in victims of intentional injury might provide several opportunities for trauma prevention programs. Underlying psychological disorders will have to be addressed to reduce the likelihood of becoming a victim of trauma.
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Thrombelastography (TEG) is used to rapidly assess coagulation abnormalities in cardiac and transplant surgery. The purpose of this study was to investigate TEG in the initial assessment of trauma patient coagulation. ⋯ The majority of blunt trauma patients in this series were hypercoagulable. TEG is a rapid, simple test that can broadly determine coagulation abnormalities. TEG is an early predictor of transfusion in blunt injury patients.
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Comparative Study
Effects of increasing airway pressure and PEEP on the assessment of cardiac preload.
Cardiac preload is most commonly assessed by pulmonary artery wedge pressure. It was postulated that the right ventricular end-diastolic volume index (RVEDVI) derived by thermodilution would be a better predictor of preload in trauma patients with high airway pressures associated with positive pressure ventilation and positive end-expiratory pressure. ⋯ Unlike the pulmonary artery wedge pressure, RVEDVI is as reliable indicator of preload in the mechanically ventilated trauma patient. This is especially true when the right ventricular ejection fraction is not severely depressed.
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Pedestrian injury accounts for approximately 14% of all vehicular-associated mortality. We performed a retrospective review of 1,014 injured pedestrians admitted to our statewide trauma center between January 1, 1990, and December 31, 1994, to determine the pattern and severity of pelvic injury in injured pedestrians, the types of associated injuries relative to those pelvic injury patterns, and the relationship between pelvic fracture treatment modalities and patient outcome. ⋯ In conclusion, pelvic fracture appears to be a substantial factor in pedestrian morbidity and mortality. Although most pedestrian morbidity and mortality is not caused by the intrinsic nature of the pelvic fracture, the severity of these injuries is correlated with the degree of destructive energy imparted to the body as a whole, as manifested by the number and severity of associated injuries and the mortality rate.