The American surgeon
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The American surgeon · May 2002
Emergency room thoracotomy: updated guidelines for a level I trauma center.
The purpose of this study was to evaluate whether 1995 study conclusions influenced patient selection and subsequent survival and whether indications for emergency room thoracotomy (ERT) could be further limited on the basis of patient physiologic status. A retrospective review of patient demographics, physiologic status both at the scene and on arrival to the emergency room (ER), and survival was performed on those who underwent ERT from July 1995 to December 1999. ⋯ Although there was a significant decrease in patients of Class I at the scene (27% vs 8%) and in the ER (58.3% vs 35.4%) the overall survival rate remained the same (2.6%). ERT could be eliminated for patients of Class I or II at the scene and for those of Class I on arrival to the ER without negating survivors; survival would improve to 16.2 per cent.
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Our objective is to report on a case of nonsurgical pneumoperitoneum and review the mechanism/gynecologic causes of such. We present a case report and review of the literature based on a MEDLINE search using the keywords pneumoperitoneum and nonsurgical. Radiographic evidence of free intraperitoneal air suggests hollow viscus rupture and usually warrants urgent surgical management. ⋯ In the patient with free intraperitoneal air on plain X-ray one should be suspicious of less common nonsurgical etiologies. The majority of patients will require laparotomy. Thorough sexual and gynecologic/obstetrical history is a valuable adjunct in identifying the patient who does not.
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The American surgeon · May 2002
Comparative StudyDo facial fractures protect the brain or are they a marker for severe head injury?
Facial fractures (FF) have been suggested to protect the brain from severe injury. However, others have stated that facial fractures are a marker for increased risk of brain injury. The aim of this study is to evaluate the association between facial fractures, brain injury, and functional outcome. ⋯ FF with TBI had a similar severity of head injury when compared with patients with head injury alone by demonstrating similar GCS, AIS of the head and neck, and early functional recovery. This analysis does not support the hypothesis that the face provides a protective effect for the brain and therefore leading to a more favorable short-term outcome. Thus patients with facial fractures should be treated with the same caution as patients with significant blunt head trauma.
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The American surgeon · May 2002
Comparative StudyTrauma management in the end-stage renal disease patient.
More than 230,000 patients in the United States are being treated for end-stage renal disease (ESRD). This group of patients has not been evaluated for trauma resource use. When these patients are involved in trauma the need for dialysis and awareness of chronic disease processes must be considered in addition to their injuries. ⋯ The complication and mortality rates among the ESRD patients were 50.8 per cent and 13.5 per cent respectively as compared with 16.3 and 4.7 per cent among the general trauma population. The trauma complication and mortality rates among ESRD patients are approximately three times greater than those in the general trauma population. Because of their coexisting medical problems and the need for dialysis trauma patients with ESRD should be cared for in trauma centers with dialysis capability and access to multidisciplinary services.
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Because of their high zinc content modern U. S. pennies that become lodged in the esophagus may react with stomach acid thereby damaging the esophageal mucosa. Management of esophageal pennies may therefore differ from that of other esophageal coins making differentiation of pennies from other coins important. ⋯ We determined the probability of an esophageal coin being a penny based on combinations of historical data and whether or not image sizes fell within the calculated range for a penny. When all data agree that a coin is or is not a penny they are nearly always correct. When there is disagreement among historical and image size data the probability that is a coin is a penny is strongly influenced by the size of the radiographic images.