J Trauma
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Six unreduced posterior dislocations of the elbow are reported and the clinical details, operative procedures, and results obtained are presented. The literature is reviewed and the necessity of triceps V-Y plasty at operation discussed.
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The present paper explores the rationale for the development of severity indices and the role such indices can play in various research and evaluation situations. Concrete examples from Emergency Medical Services research and evaluation settings are used to illustrate the potential shortcomings of designs that fail to incorporate measures of severity. A short critical review of existing indices is presented, and the ways that the indices can be refined and improved, and better used to evaluate emergency care, are summarized.
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A patient with myocardial trauma following blunt chest injury is presented who returned 4 months later with persistent cardiac symptoms. Left ventriculography showed asynergy of the mid-diaphragmatic surface of the left ventricle while coronary angiography showed normal coronary arteries. The value of cardiac catheterization and coronary angiography in patients in whom symptoms persist after traumatic myocardial contusion and in patients in whom additional coronary artery or other cardiac disease is suspected is emphasized.
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The case of a 41-year-old man with an embolus in the left popliteal artery following multiple injuries suffered in an auto accident is presented. Following popliteal embolectomy, a rupture of the descending thoracic aorta was demonstrated and repaired. The need for aortography in patients with severe blunt chest trauma who develop hypertension is emphasized.
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Massive wound edema after a burn may impair healing and help to convert partial to full-thickness injury. Cold treatment (usually by immersion) has been reported to decrease wound edema and is useful in first-aid treatment of burns. Reliable quantitative data have been lacking and frequently a superficial burn has been studied. ⋯ Immediate application of cold by immersion in 15 degrees C saline for 30 minutes reduced the edema of a deep second-degree burn and did not impair resorption rate compared with control limbs, fluid content returning to baseline after 1 week. Cold treatment beginning 2 minutes after the burn did not decrease edema formation and did impair resorption. Fifteen per cent of the edema fluid was still present 1 week postburn, suggesting further injury to the burn wound vasculature with use of cold immersion 2 minutes postburn.