J Trauma
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A patient with traumatic disruption of the thoracic duct resulting in a chylothorax and a 'chyloma' in the left supraclavicular region is described. Supradiaphragmatic ligation of the thoracic duct was necessary for treatment of the chyloma.
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Immobilization of the spine is of prime concern during transportation of trauma patients to prevent neurologic compromise. In an attempt to study certain techniques of prehospital thoracolumbar spine immobilization, we radiographically evaluated the motion of the thoracolumbar spine in a volunteer with a stable spine, a cadaver with an unstable thoracolumbar spine, and a patient with a T12-L1 fracture dislocation. Both the backboard and the Scoop stretcher offered adequate stabilization for thoracolumbar spine instability. The logroll maneuver presented the greatest possibility for movement of the spine at the unstable thoracolumbar segment.
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Historical Article
Firearms as a cause of death in the United States, 1920-1982.
We present the epidemiologic history of firearms in the United States. Firearms are among the nation's ten leading causes of death. Nearly one million firearm deaths occurred in the half-century 1933-1982. ⋯ An individual's risk of suffering a firearm death has generally risen with age. Increased firearm availability is associated with increased rates of firearm homicide and suicide. Strategies to prevent firearm deaths and injuries should be formulated in light of these findings, and heightened efforts to design, implement, and evaluate preventive measures are urgently needed.
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This study group comprises 73 patients who underwent emergency room resuscitative thoracotomy for cardiac arrest following penetrating chest and neck injuries. Overall, 12 patients (16.4%) were successfully resuscitated but only five (6.8%) left the hospital alive without neurologic defects. ⋯ Of 14 patients with cardiac arrest but with respiratory efforts and reactive pupils, three survived (21.4%). We suggest that patients with no vital signs on admission to the hospital should not be subjected to resuscitative thoracotomy.