J Trauma
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Case Reports
Spontaneous endobronchial erosion and expectoration of a retained intrathoracic bullet: case report.
In all four previously reported cases of endobronchial erosion from retained intrathoracic foreign objects, the object eventually required surgical removal. We report the case of a patient with a bullet in the left hemithorax who developed bronchial erosion and hemoptysis 3 months after the injury, with subsequent expectoration of the bullet. Although most foreign bodies within the thorax pose no special problems, migration of the object or the development of symptoms warrants investigation and possibly subsequent surgical removal of the object.
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Comparative Study
The effects of hypothermia and injury severity on blood loss during trauma laparotomy.
To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < or = 35 degrees C) upon arrival in the OR. ⋯ Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.
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The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. ⋯ Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.
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Data from patients treated in Pennsylvania-accredited trauma centers during 1989 were analyzed. TRISS expected and unexpected survivors (1.6% of all survivors) differed in many ways. Unexpected survivors were more than twice as likely to have been transferred from a nondesignated trauma center (45.8% vs. 22.8%, p < 0.001). ⋯ The percentage of unexpected survivors discharged to rehabilitation centers (61.9%) was significantly greater than that for expected survivors (8.7%), (p < 0.001). Unexpected survivors were more frequently judged "completely dependent" in five measures of functional disability than expected survivors. We conclude that unexpected survivors are a seriously injured and clinically relevant patient set, not just a statistical phenomenon.