J Trauma
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This study was performed in order to test the hypothesis that abdominal computed tomography (CT) can assist in the decision to perform laparotomy in children following blunt trauma to the abdomen. Three hundred forty children with blunt abdominal trauma underwent evaluation with CT. Abdominal injuries were detected in 84 children (25%). ⋯ Of 46 moderate to severe anatomic injuries of the liver, spleen or kidney, only five (9%) required surgical intervention because of persistent bleeding or infection. Although laparotomy occurred more frequently in the presence of a large hemoperitoneum, only 6/24 (25%) with moderate to large hemoperitoneum required surgical exploration. This analysis confirms the usefulness of CT for detection of location and extent of injury in pediatric blunt abdominal trauma.(ABSTRACT TRUNCATED AT 250 WORDS)
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The percutaneous common femoral vein catheter for volume replacement in critically injured patients.
The acquisition of venous access with the potential for massive volume infusion can be a major determinant in the survival of a critically injured patient. A percutaneously placed 8.5 Fr common femoral vein catheter (CFVC) was inserted in 366 patients in whom upper extremity veins were unavailable or inadequate for volume resuscitation. ⋯ Although 90% of trauma patients can be managed with a peripheral vein catheter, venous access in patients with the potential need for massive volume infusion can be achieved in a rapid, safe, and efficient manner using the CFVC in conjunction with the GIT. We conclude that this system can be used effectively in trauma patients with hemodynamic instability, unavailable or inaccessible upper extremity veins, suspected cervicothoracic major vascular injury and when massive volume or blood replacement is anticipated.
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Age-related limitations of physiologic reserve in burned children make adequacy of intravenous fluid resuscitation critical. To quantify fluid requirements, the medical records of all children admitted to the Army Institute of Surgical Research from 1980 to 1986 whose weight was 25 kilograms or less and burn size was 25% or greater were reviewed to quantify fluid requirements. Forty-three children ranging in age from 1.5-108 months (means 26 +/- 22 m), with 25-89% total body surface burned (TBSB) (means 41.7% +/- 14.6%), met inclusion criteria. ⋯ The net volume of resuscitation fluid, total volume less the calculated maintenance fluid requirements, was 3.91 +/- 2.2 cc/kg/% TBSB. Univariate analysis and linear regression of independent variables including age, weight, per cent full thickness, and inhalation injury revealed each had no significant influence on the volume of resuscitation. We recommend supplying maintenance volume and initiating burn resuscitation at 3 cc/kg/% TBSB.
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Comparative Study
Supracondylar fractures of the humerus--results of surgical treatment.
Forty-eight patients with supracondylar fractures of the humerus have been treated at St. Michael's Hospital in the past 10 years. ⋯ The results of this comparison suggested that the specifically designed plate provided superior fixation and better anatomic restoration of the distal humerus. Anatomic reduction, rigid fixation, and early surgery provide the best results.