J Trauma
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Comparative Study
Prospective evaluation of craniofacial pressure in four different cervical orthoses.
Cervical collars play a role in the long-term treatment of cervical spine injuries. Pressure ulcers are one of the potential complications. We previously reported on three patients who developed pressure ulcers of the scalp while wearing cervical collars. The pressure exerted by different collars was measured to determine whether this was a significant factor in the clinical problem we observed. ⋯ We recommend use of "patient-friendly" collars such as the Newport or Miami J because of their favorable skin pressure patterns and superior patient comfort. These collars should potentially reduce the incidence of soft-tissue complications and improve patient compliance.
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Registries, such as those for oncology, have demonstrated usefulness in collating information. Trauma care can be improved through the accumulation of local, regional, and state trauma statistics. The efforts to develop a National Trauma Registry in the United States are still in their infancy. ⋯ Trauma prevention has been promoted in nine (38%) states and a decrease in mortality recognized through the registry in five (21%) states. Trauma registries are labor intensive and expensive but are effective in decreasing morbidity and mortality. The need for a National Trauma Registry incorporating and comparing data from health care facilities around the United States and its possessions has the potential of improving trauma health care.
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An extremely rare fracture-dislocation of the elbow is presented in which the coronoid and olecranon processes of the ulna were fractured and the head of the radius dislocated posterolaterally. Roentgenograms are the key to diagnosis. Rigid internal fixation and early exercises resulted in a good functional result.
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To examine the mechanisms of injury and death in a commercial airline disaster and to propose preventative safety measures based on this analysis. ⋯ Fatal blunt injury secondary to deceleration forces was the most common cause of death seen in this analysis. The use of a lap belt restraint system alone is not adequate to protect passengers against these forces as shown convincingly in the automotive industry literature. What impact a better passenger restraint system may have had on survival in this disaster is unknown, however, at a minimum, it would have significantly improved survival for 6 of 28 passengers dying of isolated blunt head trauma. Minor alterations in aircraft design (secure bolting of passenger seats to the airplane superstructure) and passenger restraints (3-point lap and shoulder harness system) is proposed to positively influence survival during an airplane crash at negligible increased airline expense or passenger inconvenience.
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Fluid and sodium restriction have been advocated after brain injury as a means of controlling intracranial pressure (ICP). Recent clinical data showing no significant relationships between the amount of fluid infused or sodium administered (Na) and ICP question this practice. ⋯ These data suggest that both the volume of fluid infused and the fluid balance do affect the ICP, but the amount of Na infused does not. The lack of a significant correlation between any of the independent variables and CWC suggests that their effect on ICP is not related to cerebral edema formation. These findings, combined with the observed significant positive correlation between free H2O infused and ICP, and the significant negative correlation between serum osmolarity and ICP, suggest that HSL resuscitation increases intracranial compliance after brain injury while LR decreases it. The data also suggest that free water restriction is warranted in patients with head injuries.