Articles: trauma.
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Limited data exist regarding indications for resuscitative emergency thoracotomy (ETR) in the pediatric population. We attempt to define the presenting hemodynamic parameters that predict survival for pediatric patients undergoing ETR. ⋯ When ETR was performed for SBP ≤50mmHg or for heart rate ≤70bpm less than 5% of patients survived. There were no survivors of blunt trauma when SBP was ≤60mmHg or pulse was ≤80bpm. This review suggests that ETR may have limited benefit in these patients.
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Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3-4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.
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Editorial Biography Historical Article
Computed tomography to detect life-threatening injuries in trauma: Can we (and should we) add in patients' preferences?
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Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. ⋯ Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients.
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Triage at emergency department is performed to identify those patients who are relatively more serious and require immediate attention and treatment. Despite current methods of triage, trauma continues to be a leading cause of morbidity and mortality. ⋯ MSI is an important marker for predicting the mortality rate and is significantly better than heart rate, systolic blood pressure, DBP and SI alone. Therefore, modified SI should be used in the triage of serious patients, including trauma patients in the emergency room.