The American surgeon
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During the last 12 years, 20 patients with significant airway injuries have been treated for lesions involving the trachea, larynx, and/or bronchus. Fourteen of the injuries were the result of penetrating wounds, nine gunshot wounds, and five stab wounds. Six patients presented with blunt trauma, four as a result of motor vehicle accidents, one from a clothesline injury, and one from a crush injury. ⋯ Of the 18 surviving patients, all but two recovered totally without residual impairment. Described here is a protocol for the evaluation and immediate treatment of airway injuries that is consistent with the guidelines of the Subcommittee of Advanced Trauma Life Support of the American College of Surgeons Committee on Trauma. Aggressive initial management, high index of suspicion for injury, and meticulous repair of the injured airway are equally important steps in the successful management of these patients.
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The American surgeon · Apr 1987
Comparative StudyDiagnostic and therapeutic aspects of rectal trauma. Blunt versus penetrating.
In the last 6 years, nine patients with blunt and 16 with penetrating rectal injuries were treated at University Hospital, Jacksonville, Florida. Blunt trauma was caused by vehicular accidents in seven patients and crush injuries in two. Penetrating rectal trauma was due to gunshot wounds in ten patients and foreign body insertion in six. ⋯ Three patients died postoperatively, two of pelvic bleeding and one of head injury. Hemodynamic stabilization, colostomy and mucus fistula, presacral drainage, and rectal washout constitute proper treatment of patients with blunt or penetrating rectal trauma. Because of the greater number and severity of associated injuries, morbidity and mortality are higher after blunt rectal trauma.
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The American surgeon · Apr 1987
Penetrating trauma to the back and flank. A reassessment of mandatory celiotomy.
The optimum management of penetrating wounds to the back and flank remains controversial. Since 1980 our institution has followed a policy of mandatory celiotomy for back and flank wounds with evidence of fascial penetration. Following this policy, 34 patients underwent celiotomy for back (8), flank (22), or combined (4) area penetrating injuries. ⋯ One patient had a small bowel obstruction 1 month after a noncontributory abdominal examination. Based on this review, the authors recommend selective management of stab wounds to the back and flank. Gunshot wounds continue to warrant mandatory exploration.
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The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. A MSBOS specifies, and thus limits, the amount of blood normally crossmatched for elective surgical procedures. During the first 10 months after introducing MSBOS at our hospital, there was a 33 per cent drop in the number of units of blood crossmatched for elective surgical procedures. ⋯ Patient care was not adversely affected. Institution of MSBOS can be accomplished without difficulty by gaining input from surgeons and anesthesiologists. After implementation, follow-up is advisable to attain optimal blood use.