J Trauma
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Effective prehospital treatment of the severely injured and acutely ill by an Advanced Emergency Care system may change symptoms and signs by the time patients arrive at the hospital. To provide optimal care, physicians must appreciate the capabilities and limitations of the EMT-paramedic. ⋯ Cardiac rhythms must be documented for review. It should be the responsibility of the medical directors of such Advanced Emergency Care systems to provide supervision, refresher training, critiques, and evaluation, to establish medical responsibility and credibility.
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Although elbow dislocation occurs frequently, associated brachial artery injury is rare. Adequate treatment of this injury includes prompt arteriography, reduction of the dislocation, vascular repair, and transarticular fixation of the reduction. A case report and review of the literature are presented.
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An unusual case of traumatic false aneurysm following a puncture wound in the hand of a hemophiliac, despite Factor VIII replacement, demonstrates the necessity for careful evaluation of such patients when there is profuse and continued bleeding. Following surgical repair of the false aneurysm and the ulnar proper digital nerve of the thumb 17 days postinjury the patient had an uncomplicated recovery. Partial arterial laceration, the underlying pathology of this lesion, may be demonstrated by arteriography or surgical exploration.
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The burn eschar is the major source of infection in the severely burned patient, and it hampers healing and prevents skin grafting. Tangenital excision has been shown to be safe for rapid removal of the eschar. For the last 14 months we have used this method beginning about 7 days postinjury. ⋯ The burns ranged from 20 to 75% of body surface (mean, 40%). Because ketamine is a cardiorespiratory stimulant, ventilation and vital signs were well maintained. Psychological side effects of ketamine were minimal, particularly in the younger age group.
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A case of meralgia paresthetica with severe skin reaction following trauma to the anterolateral aspect of the thigh is presented. Relief of the patients' symptoms was achieved by neurolysis of the lateral femoral cutaneous nerve.