J Trauma
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Victims of traumatic asphyxia syndrome were studied to determine: mechanism of injury, severity of injury, characteristic physical stigmata, treatment, and long-term disability. Consecutive patients who sustained severe crush injuries with traumatic asphyxia in the 5-year period ending November 1984 were reviewed. Followup was established by personal examination or questionnaire. ⋯ Despite severity of injury, no long-term disability was detected at an average followup of 4.4 years. No long-term survivors demonstrated residual cyanosis, petechiae, swelling, or neurologic sequelae. All had returned to work or school.
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Near-complete traumatic hemipelvectomy probably carries an extremely high mortality rate. The usual techniques which have been used to control major hemorrhage associated with pelvic fractures such as transperitoneal vascular ligation, intra-arterial embolization, and packing are not applicable (14). Successful management requires prompt recognition of the nature of this injury so that surgical efforts may be directed at resuscitation and expeditious operative completion of the traumatic amputation. ⋯ Intestinal and urinary diversion allowed an uneventful postoperative recovery without significant infection. Although hemipelvectomy appears to be a radical procedure in children with major pelvic injuries, it may be lifesaving and should therefore be considered in those with severe unilateral pelvic injury and uncontrollable hemorrhage. The potential for physical rehabilitation in the group of young, mostly male patients who have survived this injury appears to be unexpectedly good.
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The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. ⋯ One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)
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The selective management of penetrating neck trauma implies an attempt to individualize care and minimize unnecessary surgical exploration. In asymptomatic patients, diagnostic studies are performed in an attempt to exclude clinically unrecognized injuries. ⋯ However, only five patients (9.4%) actually benefitted from ancillary diagnostic studies, in that angiography documented clinically unrecognized injury. In an effort to avoid the indiscriminate use of ancillary diagnostic studies, a selective management plan based on anatomic zones of injury is provided.
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Penetrating trauma of the neck has been divided into three anatomic locations. Zone III, the subject of this paper, is defined as the area between the base of the skull and the lower border of the mandible. Management of these injuries remains problematic. ⋯ An air embolism resulting in hemiparesis was the only complication of the angiographic studies. We conclude that angiography is essential in Zone III neck wounds. It facilitates triage decisions and, combined with transcatheter embolization, enables the majority of these injuries to be managed without surgical exploration.