J Trauma
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Case Reports
Bullet embolus to the right hepatic vein after a gunshot wound to the heart and its percutaneous retrieval.
Bullet emboli are rare and their management when in the venous circulation is controversial. A 26-year-old female with a gunshot wound to the heart, followed by embolization of the bullet to the right hepatic vein, had successful percutaneous retrieval of the bullet via a catheter inserted through the right femoral vein.
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The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) greater than 15, or emergency-room Trauma Score less than or equal to 14, or injuries requiring greater than 3 days hospitalization, or death. ⋯ With these same mechanisms, the sensitivity of a CRAMS scale of less than or equal to 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.
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A microcomputer system was developed which allows the user to draw the contour of a burn on a diagram on the computer screen. The per cent body surface area is then determined by direct area measurement by the computer. ⋯ Excellent correlation between the computer system and the manual Lund and Browder chart method (correlation coefficient, 0.962; p less than 0.0001) was obtained. Computerized planimetry provides a rapid, simple method of recording data and calculating total per cent burn which compares well with the manual Lund and Browder diagram.