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1. |
FOCUSED ULTRASOUND EXAMINATIONS BY SURGEONSTHE TIME IS NOW |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 181-182
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ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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2. |
SHOULD MOTORCYCLES BE OPERATED WITHIN THE LEGAL ALCOHOL LIMITS FOR AUTOMOBILES |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 183-186
Nona,
Colburn Richard,
Meyer Michael,
Wrigley Edwin,
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摘要:
A motorcycle simulator was used to assess operating performance of 14 experienced motorcyclists with varying breath alcohol concentrations. Riding error scores in three defensive and evasive maneuvers plus distance traveled in a standard time period were documented at baseline and at predetermined intervals following controlled alcohol consumption. The results revealed a positive correlation between total errors and breath alcohol concentrations within a range well below the commonly accepted legal limit of intoxication of 0.10 mg/dL. There was a highly significant increase (p< 0.0055) in an operator's tendency to leave the roadway (an error that is frequently fatal for motorcyclists), as well as a reduction in ability to complete a timed course. Moreover, performance errors increased while operators were “sobering up,” a dramatic finding not heretofore established in previous studies. Since the present definition of the legal limit of intoxication for motorcyclists is based on automobile studies, noted increases in reaction time and performance errors support the hypothesis that “legal alcohol levels” should be lowered for motorcycle operators.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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3. |
FEMORAL CATHETERS AND DEEP VENOUS THROMBOSISA PROSPECTIVE EVALUATION WITH VENOUS DUPLEX SONOGRAPHY |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 187-191
J.,
Meredith Jeffrey,
Young Elizabeth,
O'Neil D.,
Snow Kimberly,
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摘要:
Femoral vein cannulation (FVC) with 8.5F Swan-Ganz catheter introducers allows expeditious intravenous access and rapid volume infusion; however, the incidence of associated iliofemoral deep venous thrombosis (DVT) is unknown. Trauma patients (n = 76) requiring unilateral FVC were prospectively entered into a study where they were resuscitated via FVC and serially evaluated with bilateral venous duplex sonography (VDS). The incidence of DVT in catheterized femoral veins was compared with that in uncatheterized femoral veins. Catheters were removed promptly and VDS was performed within 24 hours and weekly for 1 month. Iliofemoral DVTs were identified in 11 of the 76 patients (14%). Iliofemoral DVTs occurred on the cannulated side in 9 (81.8%) compared with 2 (18.2%) on the uncannulated side (p< 0.05). We conclude that the use of the 8.5F FVC is associated with an increased incidence of DVT and that despite its convenience, this technique should not be routine.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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4. |
ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN THE NONSURGICAL MANAGEMENT OF BLUNT LIVER INJURY |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 192-199
Katsuhiko,
Sugimoto Yasushi,
Asari Tetsuaki,
Sakaguchi Takashi,
Owada Kazuhiko,
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摘要:
Injury to the intrahepatic bile duct has not been routinely examined in patients with blunt liver injury, despite the risk of formation of a biloma and hemobilia. In this study we examined the role of endoscopic retrograde cholangiography (ERC) in the evaluation of blunt liver injuries. Sixty-four of 106 (60.3%) patients with blunt hepatic injuries, admitted from April 1986 through March 1992, were managed nonsurgically; ERC was performed in conjunction with computed tomographic (CT) scanning to rule out injury to the bile duct in 28 patients. Injury to the bile duct was detected in six patients (21.4%), five of whom developed a biloma. Patients with hepatic parenchymal injuries that were observed on the CT scans were at greatest risk for injury to the intrahepatic bile duct, and our data suggested that the incidence of injury to the intrahepatic bile duct after blunt hepatic trauma is higher than previously reported. Patients with serious hepatic parenchymal injuries who are candidates for nonsurgical management should be considered for ERC to exclude the possibility of injury to the bile duct.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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5. |
ISOCHLOREMIC HYPERTONIC SOLUTIONS FOR SEVERE HEMORRHAGE |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 200-205
Mauricio,
e Silva Gerson,
Braga Ricardo,
Prist Irineu,
Velasco Elenice,
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摘要:
Two different hypertonic (2400 mOsm/L) isochloremic dextran solutions (sodium acetate, HAD; and sodium lactate, HLD; in 0.9% NaCl + 6% dextran 70) were compared with HSD (2400 mOsm/L NaCl + 6% dextran 70) as initial treatment for severe uninterrupted arterial bleeding. The substitution of dextran 70 for lactated Ringer's solution as the maintenance isotonic infusion fluid was also analyzed. Experiments were performed in pentobarbital-anesthetized dogs. A recently developed model, pressure-driven hemorrhage (PDH), which mimics uninterrupted arterial bleeding, was employed. It was found that (1) the substitution of dextran 70 for lactated Ringer's as isotonic fluid makes no difference in hemodynamic terms; (2) isochloremic hypertonic solutions are similar in their hemodynamic resuscitative effect, representing an improvement over hypertonic NaCl in terms of cardiac output, O2delivery and O2consumption; (3) HAD proved superior to HLD in terms of O2consumption and correction of pH/base excess.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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6. |
ESTABLISHMENT OF ACCURATE INCIDENCE RATES FOR HEAD AND SPINAL CORD INJURIES IN DEVELOPING AND DEVELOPED COUNTRIESA CAPTURE‐RECAPTURE APPROACH |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 206-211
Wen-Ta,
Chiu Stephen,
Dearwater Daniel,
McCarty Thomas,
Songer Ronald,
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摘要:
Prevention of head and spinal cord injuries is defined as a reduction in the incidence of these disabilities. Accurate incidence data are fundamental to any prevention program. The current approaches toward determining incidence rates for head and spinal cord injuries are summarized. Previous research has focused on passive surveillance systems and population-based registries. An alternative system for monitoring the incidence of head injuries is discussed that uses a surveillance methodology called capture-recapture. This method employs multiple population-based sources to identify cases and uses the cases that overlap between the sources to estimate the degree of undercount in the population. This estimate in turn is used to produce an ascertainment-corrected incidence estimate. Through the use of methods such as capture-recapture, accurate monitoring of the incidence of head and spinal injuries across developing and developed countries is indeed feasible.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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7. |
MORTALITY FROM ACCIDENTAL FALLS AMONG THE ELDERLY IN THE UNITED STATES, 1962–1988DEMONSTRATING THE IMPACT OF IMPROVED TRAUMA MANAGEMENT |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 212-219
Jack,
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摘要:
Falls in elderly persons primarily occur because of increasing intrinsic frailty rather than extrinsic environmental hazards. Thus declining mortality from accidental falls in the elderly predominantly reflects improved trauma management rather than injury prevention. Mortality attributed to accidental falls among individuals aged 60 to 85 years in the United States from 1962 through 1988 was analyzed using the Strehler-Mildvan modification of the Gompertz relationship of aging and mortality. This method of analysis can be used to define a disorder-specific age at which etiopathogenic influences are directly proportional to the mortality rate. From 1962 through 1988, the mortality rates (per 100,000) from accidental falls in the United States declined 63.5% (from 165.6 to 60.4) among men at age 83.4 years, and declined 76.3% (from 86.2 to 20.4) among women at age 77.5 years. This analysis suggests that trauma management, at the population level, was 2.74 times more effective in men and 4.22 times more effective in women at reducing mortality from accidental falls among the elderly in 1988 than in 1962.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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8. |
INTERNAL FIXATION OF OPEN UNSTABLE PELVIC FRACTURES |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 220-225
L.,
Leenen Chr.,
van der Werken F.,
Schoots R.,
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摘要:
From 1980 through 1990 14 patients with severely complicated unstable fractures of the pelvis were treated. There were 13 men and one woman (mean age, 28 years). Eight fractures also involved the acetabulum. The injuries were accompanied by anorectal (nine), urogenital (eight), vascular (three), and nerve (three) injuries. After resuscitation, fractures were stabilized immediately, preferably using internal fixation, notwithstanding fecal contamination in certain cases. Anorectal ruptures were treated with lavage of the distal colon and a divergent stoma. The urogenital lesions also were treated primarily. Two patients died early after treatment of accompanying injuries. Infectious complications were seen seven times. In one patient internal fixation broke down. All fractures healed with good functional results. At last follow-up examination all patients were continent for feces. It is concluded that early internal stabilization of these complex injuries achieves a low mortality rate and good functional results. Immediate repair of urogenital and sphincter lesions, with concomitant divergent stoma and lavage of the distal colon, gives good results notwithstanding the risk of infectious complications.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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9. |
SURGICAL TREATMENT OF HUMERAL SHAFT FRACTURES—THE BASEL EXPERIENCE |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 226-232
Dominik,
Heim Felix,
Herkert Peter,
Hess Pietro,
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摘要:
One hundred twenty seven patients with fractures of the humeral shaft were treated by open reduction and internal fixation using 4.5-mm dynamic compression plates (DCP). Seventy one osteosyntheses were performed primarily, 36 following attempted closed reduction, and 20 secondarily after a failed conservative treatment of about 8 weeks. A primary radial nerve palsy was present in 19 patients, and appeared subsequently in four additional patients. One hundred two of the 127 patients could be clinically and radiologically examined 1 year after internal fixation: 89 patients (87.3%) had excellent or good results with full functional recovery. Thirteen patients (12.7%) showed a limited range of motion of either the shoulder or elbow or both. This was mostly because of other fractures of the same limb or persistent neurologic impairment. We observed two transitory postoperative nerve palsies, five early failures of internal fixation because of technical errors, two pseudarthroses and four postoperative infections, which healed with one exception by suction drainage and early removal of the plate. We conclude that a correct plate fixation of humeral shaft fractures in a selected group of patients represents an alternative to conservative treatment with the advantage of greater patient comfort.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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10. |
TRAUMA FELLOWSHIP TRAININGTHE INSIDERS' PERSPECTIVE |
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The Journal of Trauma: Injury, Infection, and Critical Care,
Volume 35,
Issue 2,
1993,
Page 233-240
Thomas,
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摘要:
Trauma care is in a period of transition from care given by surgeons at the closest community hospital to care given by trauma specialists at trauma centers and within emergency medical systems. It has thus become increasingly important for the educational goals of trauma fellowship training to reflect the needs of the future system as well as the views of future practitioners. These views differ from those of surgical colleagues practicing trauma surgery, and the views of future trauma specialists should be considered during the formulation of training guidelines. This survey appears to be the first attempt to interpret the views of trauma fellows: 48 of the 83 fellows (57.8%) in the 1991–1992 national cohort responded. They made suggestions about their own training, including ways to increase surgical experiences and opportunities for academic pursuits, but gave no insight as to an appropriate mix of critical care training. Although critical care certification is a major attraction for fellowship training, the cohort does not want to be thought of as nonoperating surgical intensivists. A second year of fellowship training is seen as necessary for research and trauma systems-related studies.
ISSN:0022-5282
出版商:OVID
年代:1993
数据来源: OVID
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