J Trauma
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To determine the current role of rural hospitals and prehospital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. Specifically, we determined the proportion of crashes that required a response by emergency medical services (EMSs), the timeliness of the response, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. ⋯ The linkage of data from police, prehospital agencies, and hospitals can reveal important information about the sequence of health care for trauma patients. The rural hospitals in this county currently play a major role in the stabilization and treatment of motor vehicle crash victims.
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To identify characteristics of blunt trauma admissions associated with mortality and to derive a linear logistic model for predicting the probability of mortality. ⋯ The authors propose that use of this model may provide a more accurate evaluation of the mortality of British trauma admissions than would be obtained using models based on data from American trauma cases.
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The pain associated with multiple rib fractures can be surprisingly variable. The objective of this study was to determine the efficacy of an indwelling, percutaneously placed intercostal catheter in relieving the pain associated with multiple rib fractures. ⋯ These results confirm that an indwelling intercostal catheter provides a continuous nerve block resulting in a simple, safe procedure that can ameliorate the pain and splinting associated with multiple rib fractures. Although we experienced no complications, additional investigation is clearly needed.
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The effects of management of single forearm arterial injuries without other associated major muscular, vascular, or neurological trauma were studied. Ninety-six patients with acute injuries to either radial or ulnar arteries without obvious associated major injuries were evaluated. No patient had an ischemic hand secondary to arterial injury. ⋯ The remaining intact artery demonstrated a consistent increase in flow velocity. No subject had hand claudication; there were 51 cases (53%) of hand weakness, 27 incidents (28%) of parasthesia, and 14 incidents (15%) of cold sensitivity independent of patency of the damaged forearm vessel. In the absence of acute hand ischemia, ligation of a lacerated radial or ulnar artery is safe and cost effective.
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Comparative Study
Field triage of trauma patients based upon the ability to follow commands: a study in 29,573 injured patients.
If a trauma system is to deliver "the right patient to the right hospital at the right time," a simple triage tool that can be used in the field to rapidly identify patients with a significant risk of morbidity and mortality is vital. ⋯ The study demonstrated the GMR to be a good predictor of mortality in injured patients. Patients at risk of dying can best be identified by separating patients into those who cannot follow simple commands (GMR 1-5) from all others. This rapid and simple assessment could be useful as a prehospital tool to identify patients at risk of dying. First responders and nonmedical personnel not skilled in the use of the Trauma Score can easily determine if victims are able to follow commands and potentially identify the patients who are likely to require urgent trauma center care.