J Trauma
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Traumatic injury to the diaphragm is a relatively uncommon injury with potential for considerable morbidity if the diagnosis is delayed or missed. This review of cases of traumatic diaphragmatic injury was undertaken in order to emphasize methods and timing of diagnosis and treatment. From 1986 through 1990, 43 cases of traumatic diaphragmatic injury were admitted to the trauma unit at Sunnybrook Health Sciences Centre, for an incidence of 2% of all new multiple trauma admissions. ⋯ Surgical repair of the diaphragm was performed via laparotomy in 40 of 43 cases. Only one patient was repaired in a delayed fashion by thoracotomy for thoracic complications. A clear contrast can be drawn between blunt injuries and penetrating trauma.(ABSTRACT TRUNCATED AT 250 WORDS)
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A review of burn admission patterns to Canadian hospitals from 1966 to 1991 from Statistics Canada data was prompted by a decrease to 125 burn patients admitted to Vancouver General Hospital in 1990 after a plateau at 180-195 per year for 6 years. The total number of fires from Fire Commissioner's data and data from 20 of the 27 Canadian burn units was analyzed. Canadian burn admissions decreased from 57 per 100,000 in 1966 to 23 per 100,000 in 1989. ⋯ The number of fires decreased from 370 to 270 per 100,000 in the last decade. In 1981, 1986, and 1989 15 Canadian units treated a constant 15% share of hospitalized burns, while nine units reported a constant 7% of burn patients who also required ventilation for associated smoke inhalation injury. These trends forecast a 2%-4% decrease in hospitalized burns per capita per year.
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This study evaluated the effect of high-level positive end-expiratory pressure (PEEP) on mortality, barotrauma, intrapulmonary shunt (Qsp/Qt), and oxygen delivery (DO2) in posttraumatic adult respiratory distress syndrome (ARDS). All hypoxemic trauma patients admitted to the surgical intensive care unit (SICU) in 1989-1990 who received PEEP greater than 15 cm H2O were included. The PEEP was titrated to achieve an intrapulmonary shunt (Qsp/Qt) of approximately 0.20, and FIO2 was weaned to less than 0.50. ⋯ Mean ISS and RTS for the entire group were 32 and 5.88, respectively. We conclude that titration of PEEP to achieve a Qsp/Qt of approximately 0.20 is an attainable goal. This was accomplished with minimal hemodynamic effects or barotrauma and a low mortality rate.
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A prospective study was undertaken at a regional trauma unit (RTU) to determine the significance of cardiac complications in patients with blunt chest trauma. Radionuclide angiographic (RNA) imaging was performed as soon as possible after admission and Holter monitors were applied for 72 hours. Routine investigations included serial cardiac enzyme measurements and 12-lead electrocardiograms. ⋯ A review of abnormal RNAs revealed that all associated mortalities were attributed to noncardiac injuries. A review of postmortem reports and hospital records revealed that no deaths were attributed to cardiac failure or dysrhythmia. Thus the incidence of clinically significant dysrhythmias or other cardiac complications resulting from blunt trauma to the heart may be overestimated.
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Thirty-six patients with Allman group-2 fractures of the clavicle were treated by ORIF with 2.7-mm ASIF dynamic compression plates. The indications for surgery were an open fracture in one patient, ipsilateral fractures of the arm or the ribs in five patients, bilateral clavicular fractures in one patient, and an inability to reduce the fracture in all other patients. ⋯ The total failure rate was 12%. It is concluded that the 2.7-mm DCP is the method of choice for internal fixation of midshaft clavicular fractures and that a minimum of three screws should be placed in each fragment.