American journal of surgery
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Associated injuries and central nervous system (CNS) trauma are historically associated with poor outcome in patients with pulmonary contusions, but the value of specific factors reflecting shock, fluid resuscitation requirement and pulmonary parenchymal injury in predicting mortality in this population is not well established. ⋯ Outcome in patients with pulmonary contusion is dependent upon a number of variables including the severity of pulmonary parenchymal injury as reflected in PaO2/FiO2 ratio.
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Computed tomography (CT) is an important diagnostic modality in the evaluation of blunt head and abdominal injuries, but it has not been routinely used to evaluate blunt chest trauma. ⋯ Although CXR is less sensitive in detecting parenchymal and pleural injuries than CT, the majority of the injuries identified by CT alone are minor and require no treatment. CXR remains the primary modality for diagnostic evaluation of blunt thoracic trauma.
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Myocardial contusion is commonly diagnosed following blunt chest trauma, and has potentially lethal complications. Cost-effective case management in patients with suspected myocardial contusion is confounded by the low incidence of complications and the lack of a reliable test to predict them. The clinical usefulness of elevated cardiac enzyme levels is controversial. ⋯ Cardiac enzyme determinations have no useful role in the evaluation of patients with suspected myocardial contusion. They should be eliminated from current practice guidelines.
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Computed tomography (CT) is commonly used to evaluate patients with possible blunt intra-abdominal injury. One of its reported weaknesses is failure to demonstrate intestinal trauma. However, CT accuracy in identifying blunt small-bowel perforation has not been adequately assessed. ⋯ Blunt small-bowel injury is uncommon. When it is present, abdominal CT is usually abnormal. CT findings in intestinal perforation can be subtle and nonspecific. Any unexplained abnormality on CT after blunt abdominal trauma may signal the presence of intestinal perforation and warrants close clinical observation or further diagnostic tests.
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Clinical Trial
Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung.
The operative management of penetrating lung injuries includes oversewing of small lung lacerations (pneumonorrhaphy), wedge resection, or anatomic resection. There are penetrating injuries of the lung for which oversewing of entrance and exit wounds will predispose to intrapulmonary hematoma or pulmonary venous-systemic air emboli, yet for which formal resection would be time consuming. The technique of pulmonary tractotomy with selective vascular ligation was developed in parallel with hepatotomy for liver injuries. ⋯ Pulmonary tractotomy is a straight-forward procedure that controls deep hemorrhage from lung injuries and may obviate the need for formal resection.