J Trauma
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The "lung in shock" syndrome is a constellation of early morphologic changes in the lung within 1 hour after polytrauma as indicated by human lung biopsies. A hypovolemic-traumatic (soft-tissue trauma together with bone fractures) baboon model with reinfusion was established to study these morphologic and associated pathophysiologic events. This model was developed in order to test the efficacy of therapeutic modalities in future studies. ⋯ The fluid accumulation occurred in spite of careful control of pulmonary artery pressures during the study. More striking histologic findings were significant cellular infiltration of lung tissue, especially by leukocytes, showing evidence of degranulation. This baboon study, similar to studies undertaken in canines, shows that the hypovolemic (hemorrhagic) shock in association with trauma (fracture, soft-tissue trauma) causes ultrastructural morphologic changes that may precede potentially life-threatening functional changes in the lung.
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We report a case of complete cricotracheal transection with wide separation of the ends, a rare injury. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed, causing an unnecessary delay in treatment. Deteriorating respiratory status with progressing cervical subcutaneous emphysema brought up the diagnosis of laryngotracheal injury. Treatment was immediate and included tracheotomy and primary end-to-end anastomosis.
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Esophageal injury resulting from a gunshot wound of the chest is unusual. Even more rare is intraluminal movement of the bullet through the gut, which we found described only twice previously. The perforation was demonstrated by esophagram and confirmed by thoracotomy.
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Few past studies have examined the long-term functional outcome of geriatric patients who survive trauma. To evaluate factors that determine the long-term potential for recovery in this population, we studied 63 survivors of blunt trauma over age 65 years between 9 and 38 months after hospital discharge. The overall level of injury was moderate, with a mean Injury Severity Score of 15.8 +/- 1.1. ⋯ Among 12 patients 80 years old and over, eight patients eventually returned home. Overall, 38 patients (57%) returned to independent living after trauma. Aggressive support of the elderly trauma victim appears justified, since few patients require permanent NH care and the majority return to independent living after trauma.
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The safety and effectiveness of continuous epidural fentanyl analgesia (CEFA) in the treatment of blunt chest injury was evaluated by reviewing its use in 40 patients with multiple rib fractures or flail chest. Ventilatory function tests were performed before and after the institution of CEFA and mean changes calculated. The use of CEFA was associated with significant improvement in vital capacity and maximum inspiratory pressure (p less than 0.05). ⋯ Documented complications associated with CEFA included pruritus, urinary retention, and transient hypotension. There were no major associated complications. The results suggest that CEFA is a safe, effective method of pain control that acts to improve ventilatory function in patients with blunt chest trauma.