Adult respiratory distress syndrome

Article Abstract:

Since World War I surgeons have reported wounded soldiers developing breathing problems and respiratory failure; this condition is termed adult respiratory distress syndrome (ARDS). It is characterized by collection of fluid in the lung, reduction in lung compliance resulting in stiffening of the lung, closure of the small airways, decrease in functional residual capacity, and persistent hypoxia (lack of oxygen). ARDS is not a single disease, but rather the manifestation of the end process of various different lung injuries. There is no specific test to diagnose ARDS, although usually the arterial blood has an oxygen tension less than 50 mm or mercury and the FIO2 (fractional inspired oxygen) content is greater than 0.5; there is also reduced lung compliance and increased ventilation of the dead space of the lungs. Macrophages and polymorphonuclear neutrophils (types of white blood cells) are important to lung defense and injury. Experimental studies have shown that lung edema (fluid accumulation) decreases the antibacterial defenses of the lung. There is no specific treatment for patients with ARDS. Treatment involves early identification and elimination of the causative factor such as system-wide infection, or sepsis. If the underlying cause is not corrected quickly, hypoxia will progress. These patients require both oxygen and help breathing by means of volume-controlled ventilation with positive end-expiratory pressure. Many ARDS patients need prolonged ventilation. Appropriate nutrition is still required when the patient is removed from ventilation. Despite all treatment, the mortality for ARDS patients is between 30 and 50 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Development and progression, Acute respiratory distress syndrome, Adult respiratory distress syndrome, Traumatic shock

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Tertiary trauma care in a rural state

Article Abstract:

It has been shown that utilization of regional trauma centers reduces the incidence of death following injury. However, patients in rural areas rarely have access to this type of care. In rural areas, there is a disproportionately high incidence of death due to trauma. There are several factors that contribute to this high death rate, including delay in finding the injured person, long distances to be traveled, and lack of skilled care before the patient reaches the hospital. Efforts to improve mortality have focused on rapid stabilization of the patient in the rural area, followed by transfer to a trauma center. This does not solve the entire problem; the trauma center also is expected to play a role in providing additional, or tertiary care, to those patients whose needs exceed the resources of the rural facility. A review was undertaken of 147 patients transferred to a trauma service; 25 patients were first admitted to local hospitals, stabilized, and then transferred to the trauma center. The medical records of these patients were analyzed to determine why transfer was necessary. Areas where trauma centers can provide support to local hospitals include, making specialist surgeons available for complex procedures, supplying critical care services, and providing blood bank support. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Improved trauma care in a rural hospital after establishing a Level II trauma center

Article Abstract:

In many areas of the country trauma patients die because of the lack of organized trauma care. In some of these areas, it has been reported that 22 to 85 percent of all motor vehicle deaths could be prevented. A 1982 study of motor vehicle accident deaths in Napa County, California revealed a preventable death rate of 40 percent, which prompted the establishment of a Level II trauma center in the city of Napa. A review of motor vehicle accident deaths between 1979 and 1983, prior to the establishment of the trauma center, indicated the preventable death rate for deaths not related to the nervous system was 42 percent. After the establishment of the trauma center in April 1984, this rate fell to 14 percent. There was also significant improvement in three areas: average injury severity scores, average response time of the surgeon, and average time from admission to surgery. It is concluded that establishment of a Level II trauma center in a rural area can effectively improve trauma care and reduce trauma mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Wounds and injuries, Injuries, Wound care, Traffic accidents

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