J Trauma
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Epidural emphysema is a rare condition, and when occurs in isolation it is usually benign and resolves spontaneously after the underlying cause has been treated. Epidural emphysema is usually accompanied by pneumothorax, subcutaneous emphysema, or pneumomediastinum. ⋯ Although nonsurgical pneumoperitoneum can arise in different ways, generally pneumomediastinum or pneumothorax is observed in cases with an intrathoracic source. We report two cases of combined traumatic epidural emphysema and nonsurgical pneumoperitoneum in patients with pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema after blunt trauma.
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Hunting-related accidents occur worldwide during the hunting season. The "true incidence" of hunting-related accidents in Denmark is not illuminated in that no compulsory systematic registration procedure is available. The possible impact of alcohol consumption on the risk of being involved in a hunting accident is not yet known; however, the subject frequently is debated throughout the world. ⋯ The incidence of hunting-related accidents in Denmark seems considerably higher than reported. Compulsory and systematic registration of all hunting-related accidents involving firearms should be introduced in Denmark. Legislation rules regarding alcohol intake during hunting should be considered by the authorities.
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Burn patients with inhalation injury (INHI) require more fluid resuscitation than patients without INHI. However, the relation between INHI and fluid resuscitation may be confounded by a ventilation-induced increase in fluid retention. We therefore evaluated whether INHI was independently of continuous positive pressure ventilation (CPPV) associated with increased fluid retention. ⋯ These results suggest that increased fluid retention, which is conventionally associated with INHI, is due to the effects of ventilation and not to the effects of INHI itself. This warrants a closer evaluation of patients who are ventilated in the absence of INHI, with a view to early extubation.
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Pulseless electrical activity (PEA) secondary to both blunt and penetrating trauma is associated with minimal survival. The pericardial view of the focused abdominal sonography for trauma (p-FAST) can differentiate between patients with and without organized cardiac activity and may assist in the decision to terminate ongoing resuscitation. ⋯ The presence of PEA at any time during initial resuscitation is a grave prognostic indicator. p-FAST is a useful test to identify contractile cardiac activity. p-FAST may identify those patients with potential for survival.
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As early as 1979, suggestions were made to establish amputation teams and protocols in major metropolitan areas. It was recognized that preplanning on such calls would be valuable to carrying out rescues of that nature. Since then, questionnaires and collegial conversations reveal the existence of such teams remains the exception in our nation's cities. ⋯ A field amputation team can be an integral part of any emergency medical service system, filling an infrequently used but helpful adjunct to emergency care.