Emergency medicine clinics of North America
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Pregnancy produces unique physical and physiologic changes. These changes alter, sometimes significantly, the presentation of trauma pathology. This article examines some of the unusual findings and controversies surrounding injury during pregnancy.
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No single system exists that will guarantee triage success. Familiarity with anatomic and physiologic indicators along with an awareness of the significance of injury mechanism and existing comorbid factors is mandatory for all who participate in trauma care. Moreover, there are unique demands of the prehospital environment. Until further refinements are made, a prehospital trauma triage system should minimize undertriage and its unnecessary morbidity and mortality.
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Emerg. Med. Clin. North Am. · Feb 1993
ReviewPrehospital fluid resuscitation of the trauma patient. An update on the controversies.
The most efficacious means of prehospital volume resuscitation of the trauma patient has been debated for many years; more recent discussion has questioned the indications for any prehospital resuscitation. This article reviews the various viewpoints active in each of these areas, summarizes the current status of the disputed issues, and offers suggested directions for further research.
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The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. The clinician must select among a number of diagnostic tests and therapeutic options after the initial history and physical examination has been performed. Nine clinical entities are discussed: sternal fracture, flail chest, pulmonary contusion, tracheobronchial injuries, myocardial contusion, myocardial rupture, aortic disruption, esophageal perforation, and diaphragm rupture. Emphasis is placed on newer diagnostic modalities available for these conditions.
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An estimated 60,000 patients with severe head injury reach the Emergency Department alive each year; 50% of these patients have significant elevations in intracranial pressure at or shortly after arrival. Aggressive emergency department management with particular attention to airway management, control of intracranial pressure, and proper use of radiographic studies is crucial to successful neurologic recovery.