J Trauma
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Thirteen cases of jejunal perforation from blunt trauma are presented. There are no reliable signs or symptoms, and a normal physical examination may be seen. Free intraperitoneal air on plain radiograms is characteristically absent. ⋯ Mortality is usually associated with other serious concomitant injuries, and complications are associated with diagnostic delays. Diagnostic peritoneal lavage is a safe and reliable procedure for establishing an early diagnosis of serious intraperitoneal injury. Its routine use in all cases of serious blunt abdominal trauma is advocated.
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Comparative Study
Comparison of double indicator thermodilution measurements of extravascular lung water (EVLW) with radiographic estimation of lung water in trauma patients.
The availability for clinical use of a simple reliable method of determining extravascular lung water (EVLW) provided us with the opportunity to evaluate the accuracy of the plain chest roentgenogram in estimating EVLW in patients with severe trauma. Twelve patients who sustained blunt trauma in motor vehicular accidents were studied. Interval measurements of EVLW were made utilizing the thermal-green dye, double-indicator dilution technique and the results compared in a blind manner to estimation of lung water content on standard chest roentgenograms. ⋯ The random comparison of a change in measured EVLW with a change in radiographic density indicated that there were opposite changes in 23% of the comparisons. However, in selected patients with progressive improvement (decrease) in EVLW or gradual deterioration (increase) in EVLW over time there was good correlation between improvement or deterioration in the chest radiographic appearance with the decrease or increase in EVLW. There is some ability to ascertain in trauma patients interstitial fluid accumulation from chest radiographs, but attempts at quantitation would be fraught with considerable error.
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Prehospital blunt trauma care in one community was characterized retrospectively by the use of clinical and anatomic indices of injury severity. The predicted number of deaths derived from anatomic indices (Anatomic Index and Injury Severity Score) for patients found alive at the scene was statistically greater than observed. ⋯ All such patients received an intravenous attempt and were taken to the hospital by the paramedics rather than by commercial ambulance as was the paramedics' option. Survival correlated with the absence of clinical deterioration during the prehospital phase.
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Pulmonary vein to artery missile embolus is extremely rare. Only one other case could be found in the world's literature and the present case appears to be the only reported survivor. ⋯ Extraction of the foreign body is secondary and becomes an absolute necessity only when it interferes with distal perfusion. Catheter embolectomy is contraindicated because of possible intimal damage, so that direct arteriotomy is preferred.
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External cardiac compression (ECC) was originally developed for patients with nontraumatic cardiac conditions, but it is now used for a wide variety of emergency conditions. As an integral part of cardiopulmonary resuscitation (CPR), ECC coupled with forced pulmonary ventilation may NOT be applicable to cases of cardiac arrest following penetrating and blunt thoracic and abdominal trauma. ⋯ In another 12 patients receiving forced ventilation and prehospital ECC, air embolism to the coronary arteries was the cause of death. CPR by paramedics, physicians, nurses, or lay persons does not appear to be of value in patients who have sustained cardiac arrest from truncal trauma.