J Trauma
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The operative records of 683 patients who required an exploratory laparotomy for trauma with the findings of a liver injury were reviewed. Of the 683 patients 18% (121) sustained severe liver injuries with difficult to control hemorrhage, and 82% of the deaths, in this group of severe liver injuries, were due to exsanguination. A critical analysis of the specific surgical techniques used for hemostasis was undertaken. ⋯ The survival rate for this group of patients was 86%. Vascular isolation of the liver was used 8.3% of the cases and was successful 40% of the time. An algorithm for the successful surgical control of hemorrhage from severe liver injuries including indications and contra-indications of specific surgical techniques is presented.
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We report a patient who developed tension pneumopericardium following penetrating trauma to the chest. Lung adhering to the pleura due to previous infection prevented the lung from collapsing and resulted in diversion of the air leak into the anterior mediastinum and from there through a breach into the pericardium.
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Fracture of the occipital condyle is a rare injury. We report a patient with an occipital condyle fracture who presented with negative plain films and a cranial nerve palsy. Diagnosis was established with high-resolution computed tomography. This fracture should be considered in a trauma patient with neck pain, negative plain cervical spine radiographs, and a cranial nerve palsy.
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The diagnosis of blunt cardiac injury in traumatized patients is problematic and the implications of such a diagnosis are not clear. Although cardiac selective creatine kinase (CK-MB) assays and electrocardiograms (EKG) are the most widely available laboratory investigations, they often correlate poorly with diagnoses made on clinical grounds, or by other laboratory methods. We therefore retrospectively studied the Montreal General Hospital experience with 342 consecutive blunt trauma patients admitted to our surgical intensive care/trauma unit. ⋯ We conclude that although blunt cardiac injury is an important source of morbidity and mortality its 'diagnosis' is not the issue. Rather, it is more important to recognize which of these clinically identified 'high-risk' patients will actually develop cardiac complications. We feel our approach will enable clinicians to do this.
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Massive hemorrhage from pulmonary injuries is often refractory to hilar crossclamping. We report a simple technique, the hilar snare, to control such injuries and compare it to the standard technique of hilar occlusion with a vascular clamp. Standardized lacerations were made in the lung in each of six adult dogs. ⋯ The rate of blood loss before control was not significantly different between the two groups. Blood loss from the lacerated lung was significantly less (p less than 0.05) in the Hilar Snare group (9 +/- 4 ml/min) when compared to the Satinsky group (46 +/- 14 ml/min). The snare's flexible nature ensures complete occlusion of the hilar vessels and is a useful adjunctive technique to present methods of controlling severe pulmonary hemorrhage.