Faculty Bibliography

STUDY OBJECTIVES: To determine the relative importance of factors affecting use of barrier precautions by trauma team members. DESIGN: Prospective, nonblinded review of barrier precaution use by trauma team members over three periods. A multivaried analysis of factors affecting use then was conducted. SETTING: A 615-bed Level I trauma center in New York State with an accredited surgical residency program. TYPE OF PARTICIPANTS: Trauma team members involved in resuscitating multitrauma patients in the trauma room. INTERVENTIONS: Period 1: June to August 1991, barrier precaution use before interventions; period 2: September 1991 to January 1992, educational seminars held and material access improved by designated cart; period 3: February to June 1992, legislation mandating barrier precaution use introduced. MAIN RESULTS: Barrier precaution compliance improved significantly in periods 2 and 3. The improvement was seen in all providers studied. Improvement in barrier precaution use correlated significantly with education, materials access, and legislation. CONCLUSION: Improved compliance with barrier precaution use can be affected by education, improving materials access, and legislation. The relative importance of education versus materials access requires further study.

India reported nearly 50,000 traffic accident deaths in 1989. Yet, literature addressing the causes, timing, and preventability of these deaths is sparse. We undertook an autopsy study of road traffic fatalities in South Delhi to determine the injury patterns and incidence of deaths that could be prevented by optimal utilization of available medical resources. Among the 177 autopsies reviewed, neurological injury caused death in 60% of patients and hemorrhagic shock in 25%. Twenty-three percent of the deaths were felt to be preventable, 41% possibly preventable, and the rest not preventable. The majority of preventable deaths resulted from a failure to diagnose or treat a treatable injury. Adherence to establish principles in the hospital management of intracavitory hemorrhage could have salvaged 70% of preventable deaths.

We report a case of mediastinal widening simulating aortic rupture and resulting from fluid infused into the mediastinum via a percutaneously placed subclavian pulmonary artery introducer sheath in an acutely injured patient. The use of such catheters for resuscitation of acutely injured patients is presented, along with reported complications and their diagnosis. Necessary precautions during the use of these catheters are discussed.