Injury
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Case Reports
Penetrating left ventricular stab wound: a method of control during resuscitation and prior to repair.
A 34-year-old man with left ventricular stab wounds, suffered cardiac arrest soon after arriving in the Intensive Care Unit from the Accident and Emergency Department. He had cardiac tamponade without elevation of his central venous pressure; this was because of exsanguination into his left hemithorax. Immediate thoracotomy while still in his bed confirmed tamponade and revealed two large left ventricular stab wounds, one anterior and on posterior; the heart was in ventricular fibrillation. ⋯ This was achieved by inserting a Foley catheter into each wound, inflating the balloons, clamping the catheters and having the assistant gently retracting the catheters against each other while the operator continued with the resuscitation. When the circulation was restored, pledgeted horizontal mattress sutures were inserted on either side of each Foley catheter, which was withdrawn immediately before tying the suture. The patient was discharged home 12 days later without any complications.
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The effect of legislation for the compulsory wearing of seat belts by car drivers and front seat passengers was prospectively analysed in the county of Skaraborg, Sweden. After legislation fewer vehicle occupants were admitted to the hospitals, depsite a 40 per cent increase in crashes reported to insurance companies in the country. The frequency of seat belt wearing among injured victims was considerably lower than that recorded in regular traffic surveys. ⋯ Restrained front seat passengers had more thoracic injuries than unrestrained, but the degree of severity was less. The frequency of seat belt wearing by rear seat passengers was low, but they were injured as severely as front seat occupants. It seems important to insist on an increase in seat belt wearing for this category.
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Case Reports
Internal fixation of a segmental fracture of the femur with a Küntscher-Herzog tibial nail.
This article presents the technique and the results of internal fixation of a severely unstable and displaced segmental fracture with a Küntscher-Herzog tibial nail in a young patient with associated multiple fractures.
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Four cases of pseudomonas osteomyelitis following puncture wounds of the foot in children are presented. The infections resolved after drainage of pus and treatment with gentamicin, to which the pseudomonas was sensitive. These kinds of infections are associated with inadequate wound care and since late diagnosis is associated with troublesome morbidity, it is important that casualty officers are aware of the condition.
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The pelvic hoop apparatus was used to treat 8 patients with severe lateral compression injuries to the pelvis. Each patient had an initially satisfactory reduction of the fracture or central dislocation. The advantages of this over other conservative methods of treating such injuries are discussed.