The American surgeon
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The American surgeon · Dec 2003
Improved results using ultrasound guidance for central venous access.
Central venous cannulation is an essential part of patient management in a variety of clinical settings. The complications of cannulation may be as high as 10 per cent and include arterial puncture, pneumothorax, hemothorax, cardiac tamponade, hematoma, malposition of catheter, nerve injury, and death. Standard technique for placement of central venous catheters is by use of a blinded, external landmark-guided technique. ⋯ There were no failures in placement or misplacement of the catheters. Detection of anatomy prior to venipuncture and direct real-time visualization are the keys to success with ultrasound guidance. This study shows that placement of central venous catheters, using ultrasound guidance, may be done in a timely manner while minimizing risks and maximizing success.
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The American surgeon · Dec 2003
Thoracotomy for blunt trauma: traditional indications may not apply.
The indications for performing as urgent thoractomy after trauma are based on the criteria used for penetrating injuries. However, few data are available on the use of these indications for patients with blunt injuries. In a retrospective study (June 1996 to July 2001), we compared the indications of urgent thoracotomy after blunt injury and penetrating injury in patients who underwent thoracotomy within 24 hours of hospital admission at our institution. ⋯ In conclusion, thoracotomy following blunt trauma is associated with a high rate of mortality. The rate of nontherapeutic exploration is increased when chest tube output is the indication for thoracotomy after blunt trauma. Since the majority of such patients have multicavitary injuries that require prior operation and are commonly coagulopathic, caution should be exercised when deciding whether to proceed with thoracotomy based solely on chest tube output.
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Children restrained with lap belts may sustain severe injuries. We investigated the frequency of each type of injury associated with seatbelt contusions. The medical records of all trauma patients with ICD-9 codes for abdominal wall contusions from January 1, 1999, to December 31, 2001, were reviewed. ⋯ Forty-eight per cent of children with seatbelt contusions in our institution required surgery. The smaller patients tend to have higher frequency of abdominal injuries. The presence of seatbelt contusion indicates the possibility of severe internal injuries.