J Trauma
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A method for the reduction of anterior dislocations of the shoulder based on the Milch technique is presented. We have been using this method for the last 2 years (75 dislocations) with excellent results. The reduction is easy, produces minimal pain and discomfort for the patient, and the success rate is as high as 94.5%. The modified Milch technique is less troublesome for the patient and the physician and we strongly recommend it.
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Morbidity and mortality are doubled when hemorrhagic hypotension (HEM) accompanies a traumatic brain injury (TBI). Hemorrhagic hypotension initiates a "secondary" injury (SI) that has been attributed to ischemia, but this has not been confirmed in the laboratory. All previous studies have been of relatively short duration (less than 6 hours), allowing insufficient time to study the pathophysiology of SI, since maximal intracranial pressure (ICP) elevations may occur 16 to 20 hours after injury. ⋯ Hemorrhagic hypotension following TBI produced a significant and sustained reduction in cO2del associated with a lower cMRO2 and cO2ER, and higher ICP and CWC, than seen with lesion alone. This occurred despite adequate early restoration of sO2del. This confirms that cerebral ischemia is ongoing despite restoration of systemic hemodynamics.