J Trauma
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There is, at present, little literature to guide one in the management of a patient with a gunshot wound to the chest with normal vital signs, physical examination, and as a normal chest X-ray. The present study followed up 357 patients as outpatients at 48 hours, then 1 and 3 months. ⋯ The wound infection rate was only 1.5% with or without antibiotics, showing that prophylactic antibiotics are probably not warranted if good surgical wound care is practised. We conclude that patients with gunshot wounds to the chest with normal vital signs, physical examinations, and normal X-rays can be reasonably treated as outpatients after 4 hours of observation, at the physician's discretion.
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To determine limitations in survival and problems of single and multiple organ failure (SOF, MOF) following trauma in Bavaria, we reviewed 433 consecutive patients with multiple injuries treated at the Klinikum Grosshadern from 1978 through 1982. Most patients were young and were injured in traffic accidents. The overall mortality was 18% (78 deaths): 38 deaths were due to CNS injuries (49%), six from miscellaneous causes (7%), 15 associated with SOF (19%), and 19 associated with MOF (25%). ⋯ The temporal sequence of organ failure was lung, clotting system, kidney, and liver. Sepsis was ultimately the cause of death in eight MOF patients (42%). Earlier pulmonary and cardiovascular support beginning at the scene of the accident, and prevention and better treatment of head injury, respiratory failure, and sepsis are critical factors for increasing survival after injury.