J Trauma
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Venovenous extracorporeal membrane oxygenation and carbon dioxide removal was utilized to support a patient with traumatic bronchial disruption and associated injuries. With use of surface-heparinized perfusion equipment, low levels of anticoagulation were maintained allowing surgical repair of the bronchial injury and recovery from acute respiratory failure without significant hemorrhage.
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We report a postmortem cesarean section resulting in fetal survival, performed 25 minutes after maternal blast injury. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation represent important determinants of fetal survival. Improvement in maternal hemodynamic condition may potentially occur following the procedure. Postmortem cesarean section is advised in the event of fatal maternal trauma since it may result in fetal salvage.
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Intra-articular vertical dislocations of the patella are rare injuries that occur when a laterally or medially directed force is applied to the opposite patellar edge, causing it to rotate about its longitudinal axis. Diagnosis of this injury is not difficult with physical examination alone, but roentgenograms are necessary to rule out associated fracture and to define the direction of the articular surface. A Schanz screw is useful as a reduction tool to restore the patella to its normal relationship in the femoral groove if closed reduction proves impossible.
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Case Reports
Posterolateral dislocation of the elbow with concomitant fracture of the lateral humeral condyle: case report.
We describe a case of a 6-year-old girl with a posterolateral elbow dislocation and a concomitant fracture of the lateral humeral condyle. After reduction of the dislocation, the fracture was diagnosed and treated by open reduction and fixation, with a good functional result. In doubtful cases, oblique, heterolateral, and varus stress films, or even arthrography may be necessary.
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This study was undertaken to determine the relationship of arterial and venous base deficit (BD) to lactate levels and SvO2 in shock and resuscitation with the hypothesis that BD is an equally good indicator of the physiologic changes while being more readily accessible. Fifteen mature swine were bled serially of 25% and 40% of their calculated blood volumes, then resuscitated with lactated Ringer's and blood. Serial hemodynamic and metabolic measurements were made. ⋯ Base deficit is more readily available than lactate, and is therefore more useful as an index of shock and resuscitation. Venous BD correlates well with arterial BD and can be used when an arterial sample cannot be obtained. The SvO2 correlated well with acute volume changes but the addition of supplemental oxygen made it a less reliable indicator of hemorrhage and resuscitation.