Canadian journal of surgery. Journal canadien de chirurgie
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Blunt chest trauma continues to be an important cause of death following motor vehicle accidents in Canada. Current methods of diagnosis are presented emphasizing a physiologic approach. The most important physiologic consequence of trauma associated with chest wall instability or ruptured diaphragm is pulmonary contusion. ⋯ Methods for recognizing and treating cardiac tamponade are outlined. The indications for early thoracotomy following cardiac trauma are listed; thoracotomy should be done in a fully equipped operating room rather than the emergency room. Successful management of major chest injuries requires an aggressive physiologic approach to diagnosis and emphasis on maintaining effective ventilation and adequate cardiac output.
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The authors studied the effect of intraoperative drainage, presence of postoperative pyrexia, influence of appendectomy, chest complications and wound infection in 200 patients who had undergone routine uncomplicated cholecystectomy. One hundred patients in whom no drain was inserted were matched with 100 patients whose cholecystectomies, performed during the same period, included placement of a drain. ⋯ The rate of wound infection was substantially increased in both groups by adding appendectomy to the procedure, particularly if drains were not used. It is evident that the routine placement of a drain in an uncomplicated cholecystectomy is unnecessary and may even be harmful.
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The authors report unusual complications arising from the ingestion of a small fish bone by a 68-year-old man. These included mediastinitis, empyema, pericarditis and septic shock, probably secondary to a small perforation of the esophagus. After appropriate surgical drainage, antibiotic therapy and supportive therapy the patient made a good recovery.
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Critical emergency cases of chest trauma are of three types: those caused by blunt trauma, thoracoabdominal injuries and penetrating injuries. The author describes the management of the most commonly encountered lesions in each of these three categories. All lesions resulting from chest trauma should be considered as a critical emergency until proven otherwise.
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Of 882 patients admitted over a 6-year period to the adult trauma service at the Health Sciences Centre in Winnipeg, 325 (37%) suffered from abdominal trauma; 241 (74%) sustained a blunt injury and 84 (26%) a penetrating wound. Laparotomy is indicated when there is evidence of intra-abdominal hemorrhage, perforation of a viscus or penetration of the peritoneum. Peritoneal lavage is extremely useful in the diagnosis of intra-abdominal bleeding; it was used in 79 cases among which were four false-positive and two false-negative results. ⋯ Temporary packing and drainage sufficed as treatment in many of these patients but the placing of suture-ligatures at exposed bleeding points is often called for. Resection of hepatic tissue was required in 10 cases and ligation of the right hepatic artery in 2. Of the seven deaths in the series only one was attributed to the liver injury itself.