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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Penetrating chest trauma causes a broad spectrum of injury that requires a variety of diagnostic and resuscitative skills. Prompt resuscitation and decisive action are mandatory for patients who present in extremis, whereas a thorough diagnostic evaluation and appropriate observation are indicated in less compelling circumstances. ⋯ More sophisticated imaging techniques, with the exception of angiography, are of limited value. A systematic approach based on wound location, be it central, peripheral, or proximate to the diaphragm, should result in timely resuscitation and sound diagnostic evaluation.
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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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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.