J Trauma
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One regional trauma center's experience with a large number of seriously injured pregnant women was reviewed to identify factors affecting maternal and fetal outcome after injury. Of 318 pregnant women who suffered trauma from January 1984 through December 1988, 25 (8%) were severely injured and would have required hospital admission even in the absence of pregnancy. Physical examination, except for the inappropriate absence of fetal heart tones, was a poor predictor of fetal status. ⋯ Maternal evaluation and treatment should occur in a stepwise and organized fashion following the general principles of trauma care (ATLS guidelines) in conjunction with perinatal specialists. Uterine ultrasonography should be an integral component of the initial evaluation. With expedient resuscitation, evaluation, and intervention, maternal and fetal survival can be expected.
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Twenty-eight patients surviving severe chest injury were studied prospectively (Group I) to assess the timing of recovery and the degree of residual pulmonary dysfunction. Pulmonary function tests (PFT) were obtained within 2 weeks of discharge and serially at intervals of 3 to 6 months. In addition, 16 patients injured 1 to 11 years previously (mean, 33 months) were recalled to determine long-term respiratory disability (Group II). ⋯ Long-term respiratory disability was present in less than 5% of patients studied. We conclude that recovery from severe chest injury occurs rapidly in most patients and serious long-term respiratory disability is uncommon. These results justify the commitment of major resources to the intensive care of patients with severe chest injuries.
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MESS (Mangled Extremity Severity Score) is a simple rating scale for lower extremity trauma, based on skeletal/soft-tissue damage, limb ischemia, shock, and age. Retrospective analysis of severe lower extremity injuries in 25 trauma victims demonstrated a significant difference between MESS values for 17 limbs ultimately salvaged (mean, 4.88 +/- 0.27) and nine requiring amputation (mean, 9.11 +/- 0.51) (p less than 0.01). ⋯ In both the retrospective survey and the prospective trial, a MESS value greater than or equal to 7 predicted amputation with 100% accuracy. MESS may be useful in selecting trauma victims whose irretrievably injured lower extremities warrant primary amputation.
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Of 29 blunt trauma victims with a diagnostic peritoneal lavage white blood cell count (DPL:WBC) greater than or equal to 500/mm3 as the sole positive lavage criterion, only four underwent laparotomy at admission, and only one of these had sustained intestinal perforation. Two of the remaining 25 succumbed to extra-abdominal injuries within 24 hours, leaving 23 patients, who were followed clinically for an average of 34.7 days. None was ever discovered to have sustained intestinal perforation. ⋯ The remaining 18 underwent DPL: 17 demonstrated gross blood, and only one patient was diagnosed solely by an elevated DPL:WBC. We conclude that DPL:WBC is a nonspecific indicator of intestinal perforation from blunt abdominal trauma, and prospective studies are needed to properly define its role. Sequential determinations of DPL:WBC may be useful in the diagnosis of intestinal perforation.
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Biography Historical Article
Samuel D. Gross: pioneer academic trauma surgeon of 19th century America.
It is appropriate on the 50th anniversary of the American Association for the Surgery of Trauma to recall the most influential trauma surgeon in 19th century America: Samuel D. Gross. Gross was an innovative surgeon whose 50-year career as a surgeon caring for injured patients encompassed orthopedics, thoracic surgery, abdominal surgery, and ophthalmology. ⋯ Gross was a teacher, occupying for 42 years Chairs of Surgery at three medical schools. Gross wore the mantle of political leadership, founding medical societies that continue today as forums for the presentation and review of new treatments for injured patients. Modern academic trauma surgeons could do no better than to emulate the career of Samuel David Gross, the Patriarch of American trauma surgeons.