American journal of surgery
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One hundred nine patients with the diagnosis of pulmonary contusion were studied retrospectively. Thirteen deaths were respiratory related (12 percent of patients). All of the patients were quickly resuscitated with crystalloid solutions as necessary to restore perfusion to normal. ⋯ When survivors and nonsurvivors were analyzed by group, both individually and collectively, no correlation was found between oxygenation and oncotic pressure. Survivors and nonsurvivors exhibited similar post-traumatic courses in the PaO2/FiO2 ratios with differences not becoming significant until the eleventh day after injury. We conclude that contusion is not a progressive lesion unless pneumonia supervenes and that pulmonary dysfunction after contusion is unrelated to hemodilution.
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The diagnosis of blunt cardiac injury is often difficult to make because of the multiple associated injuries, the lack of specific physical findings, and the lack of sensitivity and specificity of the electrocardiograms and enzyme changes. The two-dimensional echocardiogram and the monitoring of filling pressures and cardiac indexes by pulmonary artery catheterization have an advantage over the electrocardiogram, CPK isoenzymes and technetium pyrophosphate scans because both anatomic and functional data are obtained, data are rapidly available, and the tests can be used repeatedly at the bedside.
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Transaxillary resection of the first rib alone was performed 97 times to relieve symptoms of irritation of the brachial plexus. Persistent or recurrent symptoms occurred in a fifth of the patients (7 and 13 patients, respectively), and necessitated reoperation using the supraclavicular approach. In all patients, at least one anomaly or acquired deformity was found that could not have been identified or safely removed by the original transaxillary approach alone. ⋯ The combined approach allows precise assessment of the thoracic outlet anatomy, facilitates first and cervical rib resection, and permits removal of any additional congenital or acquired lesions. It is associated with a low failure rate and results in few postoperative complications. However, the transaxillary approach alone may be suited for the patient with localized lower plexus symptomatology, keeping in mind the risk of recurrent symptoms associated with this technique.
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Prehospital cardiopulmonary resuscitation combined with endotracheal intubation, vigorous fluid resuscitation, and rapid transport can be effective in resuscitating trauma patients in cardiopulmonary arrest. Survival does not correlate with the injury severity score or transport time once the patient has arrested but does correlate with the mechanism of injury, endotracheal intubation, and placement of intravenous lines.