J Trauma
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Setting priorities in the management of patients with suspected injuries to both the head and the abdomen is difficult and depends on the likelihood of different injuries. Eight hundred trauma patients were retrospectively reviewed to determine the likelihood of a surgically correctable cerebral injury. All 800 patients, at the time of initial evaluation, were thought to have potentially correctable injuries to both the head and the abdomen. Of these, 52 had a head injury requiring craniotomy; 40 required a therapeutic celiotomy. Only three patients required both craniotomy and therapeutic celiotomy. There were more cases of delay in therapeutic celiotomy because of negative results of computed tomographic (CT) scanning of the head (13 cases) than there were delays in craniotomy because of nontherapeutic celiotomy (four cases). Need for craniotomy, based on emergency department evaluation, was indicated by the presence of lateralizing neurologic signs. Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy. ⋯ Patients with surgically correctable injuries of both the head and the abdomen are rare. In stable patients with altered mental status and potential injuries to both the head and the abdomen, the abdomen is best evaluated first by diagnostic paracentesis. If paracentesis does not return gross blood, CT scanning of the head should be done.(ABSTRACT TRUNCATED AT 250 WORDS)
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Two different hypertonic (2400 mOsm/L) isochloremic dextran solutions (sodium acetate, HAD; and sodium lactate, HLD; in 0.9% NaCl + 6% dextran 70) were compared with HSD (2400 mOsm/L NaCl + 6% dextran 70) as initial treatment for severe uninterrupted arterial bleeding. The substitution of dextran 70 for lactated Ringer's solution as the maintenance isotonic infusion fluid was also analyzed. ⋯ A recently developed model, pressure-driven hemorrhage (PDH), which mimics uninterrupted arterial bleeding, was employed. It was found that (1) the substitution of dextran 70 for lactated Ringer's as isotonic fluid makes no difference in hemodynamic terms; (2) isochloremic hypertonic solutions are similar in their hemodynamic resuscitative effect, representing an improvement over hypertonic NaCl in terms of cardiac output, O2 delivery and O2 consumption; (3) HAD proved superior to HLD in terms of O2 consumption and correction of pH/base excess.
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Prospective data from blunt trauma victims admitted to one hospital were analyzed to determine the significance of sternal fractures and possible associated injuries. A total of 12,618 patients were admitted over a 6 1/2 year period, of whom 2226 (17.6%) were injured while in a motor vehicle. One hundred seventy-two sternal fractures were recorded with 152 (89%) occurring in motor vehicle occupants. ⋯ There was an association with thoracic spine fractures (Chi-squared 5.871, df = 1, p < 0.05). Sternal fractures in motor vehicle occupants were associated with less injury overall (median ISS = 5.5) compared with those without sternal fractures (median ISS = 13). Assessment of such patients should include age and injury mechanism to reduce the rate of admission and investigation of patients whose sole injury is a sternal fracture without significant pain.
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Review Case Reports
Complete cricotracheal separation and third cervical spinal cord transection following blunt neck trauma: a case report of one survivor.
We report the case of a patient who sustained a scissors-type blunt neck trauma and survived the following injuries: comminuted cricoid fracture, complete cricotracheal separation, interruption of the recurrent laryngeal nerves bilaterally, multiple cervical vertebral fractures, and a third cervical cord transection. He was rendered apneic instantly at the accident site and was immediately resuscitated by coworkers by mouth-to-mouth resuscitation. ⋯ He was treated by immediate stabilization of the cervical spine, emergency neck exploration, and early primary repair of the airway injury. Any patient with cervical airway injury should be assumed to have cervical spine injury and should have neck immobilization from the beginning of resuscitation.