J Trauma
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In recent years, there has been increased debate on the indications for and value of thoracotomies done in the Emergency Department for victims of trauma. The current literature, unfortunately, does not resolve many points of contention surrounding this procedure. Using strict terms to define Emergency Bay Thoracotomy (EBT), 89 consecutive patients seen over a 2-year period in a Trauma Unit were retrospectively reviewed and analyzed. ⋯ A progressive increase in survival rate was observed with increased use of the procedure. A review of the prognostic factors found in this study and comparison with other published studies indicates that clear definition of the patient population and patient status is essential before aggregated data are used as a basis for therapeutic policies. Educational and research efforts must focus on determining which patients have zero prognosis after initiating resuscitation, rather than on denying care to any group, even when only a few will respond.
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During a 3-month period an autopsy study was performed on cases of penetration lung trauma to assess the frequency and significance of air embolism. The technique of detecting air in the chambers of the heart and the coronary vessels was, in the early part of the study, to flood the pericardium with water and observe for air while stabbing the heart chambers. Later it was found preferable to manipulate the removed heart in a basin under water. ⋯ In nine of these cases significant amounts of air were demonstrated in the heart and coronary vessels using our autopsy techniques. Case reports are summarized to emphasize the clinical picture (unexplained hypovolemic shock, cerebral symptoms) and autopsy findings (evidence of air embolism). Successful management requires an awareness of the condition, correction of those factors exacerbating air embolism, and prompt thoracotomy in order to clamp the injured lung pedicle in patients failing to respond to therapy.
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Trauma of the bladder from external force is associated with severe multiple injuries and the resulting mortality rate is substantial. The major associated injury was fracture of the pelvic bones which was present in 346 (83%) of the 417 patients with bladder trauma. ⋯ Radiologic evaluation of the bladder by a retrograde cystogram using 400 ml of dye is recommended to diagnose the type of bladder injury. Nonoperative (catheter) management of extraperitoneal rupture of the bladder was used in 18 patients and resulted in complications in four of the 18.
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Standard burns were sequentially produced on the backs of Sprague-Dawley rats at 0, 1, 2, and 2 1/2 hr, followed by the IV injection of Evans blue dye. All animals were killed at 3 hr, and burns evaluated by wet/dry weight ratios, and Evans blue extravasation scored 1-4 by two observers. Five groups of rats were compared to controls. ⋯ All treated groups showed significant reduction of Evans blue dye extravasation. Wet/dry weight ratios were significantly reduced in rats treated with FPL 55712 and ketoconazole before or after burning. These data support the postulate that oxygenation products of arachidonic acid, particularly Tx and LT, are important mediators in early burn edema.