J Trauma
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Review Case Reports
Long bone fracture in a spinal-cord-injured patient: complication of treatment--a case report and review of the literature.
Long bone fractures in patients with spinal cord injuries are difficult to manage. A case is presented in which complications arose after a femur fracture in a paraplegic patient was treated by closed fixation in a long leg circular plaster cast and the literature on management of long bone fractures in patients with spinal cord injuries is reviewed.
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Review Case Reports
Hand infections secondary to catfish spines: case reports and literature review.
Catfish are one of the few freshwater fishes known to be venomous. Although "finning" of the hand is a frequent injury incurred by catfish anglers that results in intense pain, it rarely results in any long-term sequelae. We present three cases in which acute soft-tissue infections developed, necessitating ray amputations in two patients. The unique habitat and anatomy of the catfish are described and preventive and therapeutic measures are discussed.
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During a 3-year period (1986-1989), 8 patients were seen at St. Louis University Medical Center exhibiting the stigmata of traumatic asphyxia. Fewer than 200 cases of traumatic asphyxia have been reported and there is only a single report of a cardiac injury. ⋯ There was one death in the series, a patient with rupture of the right ventricle and severe splenic and liver injuries. The cardiac status of the patients was evaluated by serial serum cardiac enzyme determinations, electrocardiograms, and echocardiography. This report illustrates the importance of complete cardiac evaluation in patients with traumatic asphyxia.
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Comparative Study
A comparison of EMT judgment and prehospital trauma triage instruments.
A number of instruments have been devised to aid in the triage of trauma patients. Little work, however, has been done to demonstrate that these triage instruments offer an advantage over the judgment of an emergency medical technician (EMT) in determining which patients require transportation to a trauma center. The purpose of this study was to compare EMT judgment against three scoring systems; the triage-revised Trauma Score, the Prehospital Index, and the CRAMS scale. ⋯ We found that the EMT prediction of mortality was as accurate as the various scores. In a subset of patients, we also found that the EMT assessment performed as well as the scoring systems in identifying patients who either died or required emergent operative intervention. We conclude that EMT judgment is as accurate as these three scoring systems in identifying patients at high risk for death or the need for immediate operative intervention.
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The initial hemoglobin (Hb) levels and vital signs of 1,000 patients treated with intravenous infusion in the admission area of Groote Schuur Hospital Trauma Unit were recorded. The mean Hb level of 860 patients with mild or no signs of shock was 12.7 g/dL. Lower mean Hb levels were noted in 91 moderately shocked patients (11.8 g/dL, p less than 0.0001) and 49 severely shocked patients (9.9 g/dL, p less than 0.00001). ⋯ Hypovolemia was judged to be the major factor in causing death in 13 (86.7%) of the 15 patients with a Hb level under 8 g/dL who died. A low Hb level observed soon after injury is usually an indicator of serious ongoing hemorrhage and has important implications for management and prognosis. Measurement of the Hb level may prove useful in prehospital assessment of the level of trauma care required and also in injury severity scoring as a predictor of mortality.