The American surgeon
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Fasciotomy has been used as a prophylactic measure against development of compartment syndrome and as a treatment modality when the syndrome has developed in patients suffering vascular trauma. The hospital records of 36 patients who underwent surgical repair of their traumatic vascular injuries were reviewed. All 36 patients had at least one indication for fasciotomy at the time of repair; i.e., ischemic time of more than 6 hours or combined arterial and venous injury. ⋯ Four of the fasciotomy-related complications were infective in nature. Only one patient who did not undergo fasciotomy at the time of original repair developed a compartment syndrome during the postoperative period. Selective fasciotomy based on well-defined criteria instead of serial physical examinations or measurement of compartment pressures will effectively save limbs; there is an increased hospital stay.
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Rectus Sheath Hematomas are an uncommon cause of abdominal pain. There are many etiologies for this entity. The physician must be aware of this entity and include it in his differential when a patient presents with acute abdominal pain.
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The American surgeon · Jun 1994
Comparative StudyRole of computed tomography scan in evaluating the widened mediastinum.
Thirty-eight blunt trauma patients with a suspicion of thoracic aortic injury were assessed by computed tomography (CT) scan, aortography, and chest x-ray. Twenty-eight of the 38 patients had widened mediastinum by chest x-ray; four of 13 CT scans were abnormal. No patient with a negative CT scan had aortic injury by aortogram. A normal, non-dynamic CT scan of the chest should influence one's decision-making in the need for aortography.
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The American surgeon · Jun 1994
Comparative StudyAutomated severity scoring in level I trauma patients.
The authors evaluated the sensitivity and specificity of a computerized Simplified Acute Physiology Score (SAPS) for outcome prediction in Level I trauma patients admitted to a Surgical ICU (SICU). SAPS was compared with the combined Trauma Score (TS) and Injury Severity Score (ISS). 1434 consecutive trauma patients admitted to the SICU over a 3-year period were studied. All patients had the SAPS automatically calculated on the first SICU day. ⋯ The mean SAPS was 8.1 (+/- 2.5). Survivors had a significantly lower SAPS than non-survivors, 7.0 versus 20.2 (P < 0.0005) and a shorter LOS, 2.5 versus 4.9 days (P < 0.002). ROC curve analysis revealed no statistically significant difference in the areas under the two curves, indicating that the SAPS was equivalent to TS combined with ISS in outcome prediction (P > 0.70).(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Mar 1994
Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head-injured trauma patient.
Forty-three trauma patients underwent tracheostomy (TRACH) and percutaneous endoscopic gastrostomy (PEG) over 21 months. Thirty-one patients had a head injury with Abbreviated Injury Scale > or = 3 associated with multi-trauma. This study was undertaken to analyze demographic and outcome variables with respect to timing of TRACH/PEG in this population. ⋯ Full Esophagogastroduodenoscopy performed at the time of PEG had a high diagnostic yield in both groups. We conclude that TRACH/PEG performed within the first 7 days of injury in the head trauma patient is the procedure of choice for long-term airway protection, mechanical ventilation, and enteral nutrition. Combined use of these procedures reduces ICU and hospital LOS and shortens the course of MV.