J Trauma
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The benefits of emergency room thoracotomy (ET) in the treatment of blunt trauma are controversial. We retrospectively reviewed 38 consecutive cases in whom blunt trauma required thoracotomy as part of the resuscitative maneuver. ⋯ Victims of blunt trauma presenting without signs of life are poor emergency thoracotomy candidates, and we suggest that in such patients this procedure be abandoned. Guidelines for emergency room thoracotomy are suggested: that ET should be used in penetrating chest trauma; that it is indicated for noncardiac injuries only if there is pupil reactivity, voluntary respiratory efforts, or purposeful movement, initially or during resuscitation; following ET, if spontaneous cardiac activity cannot be maintained and systemic blood pressure cannot be maintained at least at 70 mm Hg for 30 minutes, patients should be considered unsalvageable.
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The roles of local wound exploration (LWE) and peritoneal lavage (PL) in the selective management of stab wounds to the lower chest and abdomen were evaluated prospectively in 53 patients. Twenty-four patients underwent immediate laparotomy for obvious clinical signs of intra-abdominal injuries. Twenty-nine patients with evidence of anterior abdominal fascia penetration or equivocal LWE had PL before laparotomy. ⋯ Three of these injuries were considered significant with an overall false negative PL of 15%. Laparotomy performed on the basis of LWE resulted in nine patients (31%) having an unnecessary laparatomy. Careful physical examination, the results of local wound exploration, and peritoneal lavage should be considered in selecting patients with abdominal stab wound for laparotomy.
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The impact on mortality of stabilization in the field before transport of patients with penetrating heart injuries is unknown. This retrospective study compares patients promptly transported with minimal therapy after penetrating cardiac injuries with such patients who had received prolonged attempts at stabilization in the field. During the period of study from 1979 to 1981 23 patients with penetrating wounds of the heart were seen at our institution. ⋯ In this group of patients, a salvage rate of 80% was achieved if transport delays were minimized. In contrast, no patients in whom field resuscitation with concomitant prolonged prehospital delay survived. These data suggest that prompt transport to the hospital without attempts at field resuscitation provides a better chance for survival among patients with penetrating heart wounds.