J Trauma
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In a study of diabetic patients with hand infections reviewed at Jackson Memorial Hospital, University of Miami School of Medicine, 20 such diabetic patients with hand infections were found. The most outstanding result was that seven of the 20 had amputation either to control infection or because the function of the extremity was impaired by the remaining ravaged part. ⋯ The bacterial organisms of the infections were variable, but a predominance of Gram-negative organisms were cultured in twelve of the 20 patients. Early aggressive management, including surgical debridement and intravenous antibiotics, is recommended to prevent unnecessary amputations and improve residual function.
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An Emergency Medical Services (EMS) system with the capabilities of rapid response, patient extrication, basic life support, advanced life support, radio communication, and transportation provides appropriate care for a wide spectrum of injured and acutely ill patients. The validity of the selective dual response system in demonstrated by: 1) rapid provision of basic life support, 2) appropriate availability of advanced life support, 3) conservation of educational and fiscal resources, and 4) the enchancement of knowledge and manipulative skill expertise of relatively few, but busy, EMT-paramedics who are provided close medical supervision and support.
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Traumatic hemipelvectomy is a devasting injury which few patients survive. A survivor of traumatic hemipelvectomy is described. Immediate and long-term management include prompt resuscitation, vascular control, urinary and fecal diversion, wound debridement, wound closure, and physical and psychologic rehabilitation.
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This report presents a patient in whom measurement of intracompartmental pressures objectively supported the need for fasciotomy. Method of measurement, technique of using the opposite extremity as a control, and normal tissue pressure of 14--19cm H2O are also discussed.
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A distinctly rare case of a bullet embolus to the internal carotid artery following an abdominal gunshot wound is reported. Unusual aspects of the case are discussed with references to the literature. Pathways the bullet may have traversed to reach its final location are proposed.