J Trauma
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We report a retrospective study of 198 trauma patients brought directly to a trauma operating room by an air ambulance system. Despite rapid transport, expert prehospital resuscitation, and the capability of early surgical intervention, the overall mortality was high (57%). ⋯ Optimal trauma care failed to show encouraging results in this preselected group of patients with predominantly blunt and multisystem injury. The justification and cost effectiveness of this system of trauma care is discussed.
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Reduction of liver ATP in proportion to the severity of shock and hypoxia is well known. We have studied the interrelationships among arterial oxygenation, arterial pH, and liver ATP in experimental hypoxia and in hemorrhagic shock in rats. No significant correlation was found between liver ATP and arterial pH in both hemorrhagic shock and hypoxia and between liver ATP and arterial PO2 in hypoxia. Induction of experimental observations suggest that in this form of hemorrhagic shock, arterial pH may be a sensitive indicator of decreased hepatic perfusion and impaired liver ATP production.
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Acute subdural hematoma (ASDH) due to ruptured bridging veins occurs under acceleration conditions associated with rates of acceleration onset. That this is due to the strain-rate sensitivity of these veins was confirmed in an experimental model of ASDH. ⋯ A mathematical model embodying the known mechanical properties of subdural veins was used to develop tolerance criteria for the occurrence of ASDH. This tolerance curve was consistent with the clinical and experimental data but differed from tolerances previously proposed for head injury.
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In 34 cases of cervical spine facet dislocation treated between 1975 and 1979, the dislocations were reduced by closed methods and immobilized in the halo thoracic brace. If closed reduction was unsuccessful, open reduction and fusion were performed. ⋯ Patients with facet dislocations and minimal neurologic injury are at risk of late instability following halo thoracic brace immobilization, and therefore open reduction and posterior cervical fusion may be advisable for them. However, surgical fusion carries a high incidence of long-term neck pain and stiffness, and is indicated only in patients at risk of developing late instability.
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Survivors of innominate and other major cardiovascular injuries are being seen with increasing frequency. Penetrating injuries more frequently involve the distal innominate artery and innominate veins. Associated subclavian and carotid artery injuries are more frequent following penetrating trauma. ⋯ A variety of operative exposures is useful but the selection of incision frequently depends upon the presence or absence of associated mediastinal injuries. Partial or complete median sternotomy in combination with various cervical and thoracic extensions is advised. Successful management of innominate artery injury can be performed without the aid of cardiopulmonary bypass or arterial shunts.