J Trauma
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Comparative Study
A population-based study of outcome after injury to car occupants and to pedestrians.
The literature indicates that trauma center pedestrian mortality rates approximate twice that of injured car occupants. This study was performed to test the hypothesis that outcomes will be similar given similar degrees of injury severity if analyzed from an epidemiologic perspective. Differences are expected in the cause and place of death because of different injury profiles. ⋯ These findings have important implications for prehospital care. A policy of "scoop and run" is advocated for injured car occupants in shock because of the high frequency of aortic and abdominal injuries. Advanced life support measures are appropriate at the scene to stabilize the airway and to protect the entire spine in pedestrians with multiple injuries because of the high frequency of brain and vertebral trauma.
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The results of retrospective analysis in the treatment of 189 wounded with colorectal lesions treated at the Military Medical Academy from July 1991 to December 1993 were presented. Primary surgical management was performed in 33 (17.5%) wounded. The others were transported into this hospital for further treatment after primary surgical management in war hospitals in the combat zone. ⋯ Postoperative complications (colorectal cause) were found in 40 (21.2%) wounded. Reoperation was performed in 35 (18.5%) wounded. Total mortality rate was 10.1% (19 wounded).
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Case Reports
Computed tomography detection of active mesenteric hemorrhage following blunt abdominal trauma.
Following blunt abdominal trauma, patients still may be actively bleed ing, despite seeming hemodynamically stable. By detecting extravasation of contrast-enhanced blood in the absence of any other evidence to support solid visceral injury as the source, computed tomography (CT) scanning was able to indicate ongoing hemorrhage in two patients, thought most likely of mesenteric origin. This information influenced the decision for intervention, which in these two cases was laparotomy, where bleeding torn mesenteric vessels were confirmed.
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The authors describe an approach and a novel technique to solve a leaky endotracheal tube cuff problem in ventilator-dependent patients without immediately resorting to the potentially hazardous task of changing an endotracheal tube.
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Human burn injury is associated with an inflammatory response and related hyperdynamic cardiovascular profile. Increased production of nitric oxide (NO), a potent endogenous vasodilator, has been reported in patients with inflammatory states, including sepsis, but not after trauma other than burns. We studied whether plasma levels of the stable byproducts of NO, nitrite (NO2-) and nitrate (NO3-), are increased in burn patients. ⋯ Human burn injury is associated with an increase in NO production. In this small-size study, NO production was not proportional to burn area, and seemed to be further enhanced in septic patients.