Seminars in thoracic and cardiovascular surgery
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The majority of chest injuries in children may be effectively diagnosed and treated in the emergency room area, if an organized plan is followed and a high index of suspicion for specific injuries is maintained. Unique features of pediatric anatomy and physiology require innovative adaptation to provide maximal effective resuscitation. Children in this sense are not merely "little adults." Of those few blunt and penetrating injuries that require operative management, operative techniques do not differ from those employed in adult trauma patients.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1992
ReviewBlunt cardiac trauma: clinical manifestations and management.
In conclusion, blunt cardiac trauma is the leading cause of fatalities following motor vehicle accidents. Although many of the patients with anatomic cardiac injuries die at the scene, with improved prehospital care these patients have more likelihood of surviving the first hour and presenting to an emergency room alive for definitive treatment. Prompt recognition of the injury based on the mechanism and a high index of suspicion must lead to immediate surgical intervention in order for these patients to survive. ⋯ This will allow better allocation of scarce hospital resources rather than blindly pursuing "routine" (expensive) work-ups. The sequelae of these injuries are generally nonfatal. If serious sequelae do arise in the ICU or in the OR, prompt treatment with inotropic support is usually successful.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1992
ReviewThe multi-injured patient: the Maryland shock trauma protocol approach.
Thoracic trauma will continue to be a major cause of morbidity and mortality in our population. Improvement in ambulance transport systems and prehospital care has improved the salvage rate. It is hoped that earlier recognition, better understanding of the pathophysiology, and improvement in management will further reduce the number of deaths due to thoracic injuries.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1992
ReviewThe diagnostic and therapeutic approach to chest trauma.
The diagnosis of thoracic injuries is now accomplished by a combination of time-honored techniques and new modalities such as echocardiography, CT, and thoracoscopy. Operative approaches are reserved for exsanguination, significant false aneurysms, tamponade, and perforation of the main aerodigestive tracts.