J Trauma
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In order to quantitatively investigate the usefulness of intraosseous fluid and drug administration as a resuscitative modality, we studied the infusion flow rates of crystalloid solutions obtainable at varying infusion pressures into the bovine tibial medullary cavity and time to initial as well as 90% of maximal effect of intraosseously administered vasoactive drugs. Mean infusion rates +/- SEM (n = 6) at 300, 200, and 100 torr and atmosphere + 81 cm H2O were 41 +/- 2, 32 +/- 1, 27 +/-2, and 10 +/- 1 ml/min, respectively. The mean time (+/- SEM) to initial effect of intraosseous injections (n = 6) of either 0.5 mg epinephrine or 50 mg ephedrine was 17 +/- 3 seconds and mean time to 90% of maximal effect was 45 +/- 5 seconds. These results provide a quantitative basis for resuscitation by fluid and drug administration via the tibial malleolar intraosseous route and suggest that when performed in appropriate situations, the technique may have clinical utility.
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Blunt chest trauma, if sustained selectively to the midchest or precordium, can result in a variety of cardiac injuries (3, 7). These lesions may involve separately or together all structures of the heart, including pericardium, myocardium, valves, and coronary arteries. Depending on the extent of trauma, such injuries can cause varying amounts of mechanical or electrical dysfunction. ⋯ High-grade atrioventricular (A-V) block has rarely been recognized clinically in association with nonpenetrating heart trauma (1), perhaps because of its rapid replacement by other dysrhythmias. It was, therefore, of interest when a patient presented to this institution in third-degree heart block following a blunt chest injury. Specifics of her illness are discussed.
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A case of crush injury to the lower extremities of an ironworker involved in the demolition of a bridge is presented. Extrication of the entrapped limbs was complicated by weakening of the bridge support due to acetylene torch cutting. After 3 hours the decision was made to complete the traumatic disarticulation of the right knee on site. Essential elements in the successful completion of such field intervention are presented and the unusual features of the case are emphasized.