J Trauma
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Historical Article
Resuscitation of trauma patients with type-specific uncrossmatched blood.
The present study was undertaken to determine the safety of type-specific uncrossmatched blood transfusions for severely hypovolemic trauma patients. During a 3-year period 875 units of type-specific uncrossmatched blood were given to 160 severely hypovolemic trauma patients who could not be adequately resuscitated with crystalloid solutions. ⋯ Subsequent major crossmatch failed to identify either blood incompatibility or significant antibodies. Type-specific uncrossmatched blood is safe and is a rapidly available alternative to crossmatched blood in the severely hypovolemic trauma patient.
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Within 24 hours after a full-thickness burn injury, predictable alterations occur in the dermal vasculature. At the immediate site of injury, vessels lose patency. In the periphery, vasodilation and increased permeability become widespread. ⋯ Significantly, ibuprofen was effective in preserving the dermal vasculature, even when administration was delayed as long as 6 hours after burn trauma. Pharmacologic actions not associated with the production of thromboxane or prostacyclin appear responsible for the protective effects of ibuprofen during burn injury. Such findings do not support an important role for either thromboxane or prostacyclin in the development of vascular alterations following burn injury.
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Blunt trauma to the larynx is an uncommon injury that results in a wide spectrum of damage to the endolaryngeal soft tissues as well as underlying cartilaginous skeleton. Recognition of these injuries is essential if long-term problems with compromised airway and voice quality are to be avoided. Although minor soft-tissue injuries do not mandate surgery, severe soft-tissue damage or cartilaginous fracture-dislocations require exploration and repair. ⋯ Frequently, the degree of soft-tissue injury is used to judge the likelihood of damage to the thyroid and cricoid cartilages. Computed tomography (CT) is an excellent noninvasive technique for examining the laryngeal skeleton. Laryngeal CT may be successfully used to determine the need for open exploration and repair in selected cases of blunt trauma to the larynx when clinical findings are equivocal for cartilaginous damage.
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Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. ⋯ There were no significant complications from the cardiac repair. The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma.
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Case Reports
Traumatic hemipelvectomy in combination with traumatic amputation of an upper extremity.
This is a report of a 16-year-old survivor of a traumatic hemipelvectomy in combination with an amputation of the upper extremity on the ipsilateral side. The injury was caused when the patient fell under a railroad train. There were associated injuries of the genitourinary tract and the rectum. Factors that contributed to the patient's survival were: 1) the excellent care he received at the scene of the accident by the paramedics of the regional emergency care system; 2) a rapid transportation to the hospital by a life flight helicopter; and 3) a concentrated effort by the general surgery, plastic surgery, and urologic surgery teams in providing vigorous, sustained, and comprehensive preoperative, operative, and postoperative care.