Injury
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There is growing awareness that the majority of traumatic splenic injuries should be managed non-operatively. This review of all traumatic spleen injuries at a large community teaching hospital over a 10-year period (1978-1988) confirms that principle. The study generated selection criteria and principles of non-operative management. ⋯ Two patients (9 per cent) initially treated non-operatively required splenectomy. Haemodynamically stable adult patients with blunt splenic injuries can be managed non-operatively if monitored in a setting where immediate operative intervention is available. Operative intervention is indicated not only in haemodynamically unstable patients, but also in patients who require more than four units of blood during a 48-h period.
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The response to major trauma in Britain has been demonstrated to be inadequate. One of the suggested approaches to tackling the problem has been the setting up of rapid response trauma teams at district general hospitals. ⋯ Numbers of patients were not sufficient to draw any firm conclusions, though no dramatic improvement in outcome was evident. Problems in setting up such a team are discussed.
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The 79 survivors of the M1 aircrash have been assessed at an average of great britain 1 year after the accident. Return to work, continued hospital care and recovery from injuries has been found to be related to the severity of injury. The 188 pelvic and limb fractures have been reviewed and the incidence of complications from these injuries has been low. Spinal and lower limb injuries account for the majority of the residual disability.
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In the examination of patients with severe thoracic and/or abdominal trauma not requiring surgical exploration, special attention should be given to signs of traumatic diaphragmatic herniation (TDH). We analysed the hospital records of 63 patients with traumatic injuries of the diaphragm. Of these patients, 39 had suffered a blunt trauma in a traffic accident, 21 penetrating trauma, and three had fallen from a great height. ⋯ If diaphragmatic injury is suspected, ultrasound investigation must be performed. If the physician is still in doubt, computed tomography should be performed. At laparotomy, the diaphragm should always be thoroughly examined for lacerations.