J Trauma
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Fifty-eight patients with arterial injuries of the extremities were treated during the past 8 years. Fifty-one had acute injuries and seven had nonacute injuries. Blunt trauma or shotgun wounds caused 74% of the injuries, and 55% were associated with skeletal trauma. ⋯ The injuries leading to amputations had associated prolonged ischemia, severity of injury, and associated venous, soft tissue, and skeletal injury. The nonacute injuries were in the form of false aneurysms, pulsating hematomas, AV fistula, and delayed bleeding. These were easily managed without any significant complication.
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Optimal management of a severely injured child depends upon instant availability of a wide variety of emergency equipment and supplies. Some of these items are not commonly found in trauma rooms designed for adults, and others are required in a range of sizes unique to child care. After a major resuscitative effort the trauma room is a shambles from which it must be restored rapidly to receive the next trauma victim. ⋯ This list was patterned after a similar checklist used in the Emergency Department of the Parkland Hospital in Dallas and was developed for children by the Trauma Committee of the American Pediatric Surgical Association. It has been tested and refined in the Trauma Room of the Children's Hospital, Columbus, Ohio, during a 2-year period in which 100,000 children presented to the emergency department. It should be helpful in any emergency department which receives seriously injured children.
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A forward evacuation hospital functioned in the southern front in October 1973 Israeli-Arab War as an intermediate unit in the Israeli casualty management logistics. Casualties were characterized by frequent multiple-system injuries and variable combinations of penetrating wounds, blunt trauma, burns, and inhalation injury, with an increased incidence of associated blunt trauma. ⋯ Performance of operations in a forward evacuation hospital did not increase the number or severity of postoperative complications. Morbidity and mortality were related to the nature and magnitude of injury.
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Rupture of the pectoralis major muscle in a healthy male weight lifter is described. Complete avulsion of its insertion was surgically repaired by suturing followed by immobilization for 6 weeks. Two years later the patient won a national championship by lifting 455 lb in bench-press, and has recovered full function of the shoulder.
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Radial artery cannulation for constant monitoring of arterial pressure and blood gases has become commonplace in the care of the seriously ill. The radial artery is readily accessible and is often regarded as carrying a negligible complication risk, because there is extensive collateral arterial flow in the hand. To the rarely reported cases of gangrene of the hand secondary to cannulation of the radial artery, this publication adds two, both survivors. One, a 46-year-old female with a clinical picture suggestive of mild Raynaud's disease, was treated by closed mitral commissurotomy; the second, a 44-year-old female, was treated for drug overdose complicated by cardiac arrest and renal shutdown.