J Trauma
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Over a 54-month period 6,142 patients were consecutively admitted to our Level I trauma center. Ninety-two blunt trauma patients required massive transfusion (MT) of 20 or more units of packed red blood cells (range, 20-126). Eighty-two per cent of all transfused blood was given within 24 hours of admission. ⋯ Thirty-two patients (74%) returned to work. We conclude that: 1) blunt and penetrating trauma patients receiving MT have similar survival rates of 50%; 2) shock, closed head injury, and age predict increased mortality but do not preclude survival; 3) long-term outcome in blunt patients requiring MT is excellent. Post-discharge death is rare and 3/4 of the survivors return to work, justifying the high cost of acute care.
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Increased fuel economy and reduced injuries have been portrayed as incompatible goals, based on the false assumption that vehicle weight is the determining factor in both. Physics predicts that size and velocity, not weight, are the primary factors affecting crash forces, while increased weight or increased velocity consumes more fuel. ⋯ Fuel use is a function of weight and horsepower. Injuries and fuel use can be reduced by reducing vehicle horsepower without changing vehicle size.
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Cardiac injury following blunt trauma is an important cause of morbidity and mortality and is often unsuspected. Isolated chamber rupture and valvular injury are infrequent but recognized consequences of nonpenetrating trauma. This report describes a patient who developed a perimembranous ventricular septal defect and disruption of the septal leaflet of the tricuspid valve as a consequence of blunt trauma. Diagnosis and management of traumatic ventricular septal rupture are discussed.