Southern medical journal
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Southern medical journal · Jan 1987
Penetrating neck injuries: experience with selective exploration.
Although many authors have stated that surgical exploration should be mandatory for all neck wounds that penetrate the platysma, recent reports from many centers now claim that selective exploration is both safe and reasonable. A policy of selective exploration based on clinical presentation, anatomic location, and results of diagnostic studies has been followed at The Cooper Green Hospital in Birmingham, Alabama, for the past 13 years. We report a study of penetrating neck wounds in 136 consecutive patients admitted to The Cooper Green Hospital from 1972 to 1984. ⋯ There were no deaths or complications related to the neck wounds in the 59 patients observed. Results of 27 explorations (35%) were negative. We conclude that selective exploration of penetrating neck wounds is both safe and reasonable.
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This case report describes a new radiologic finding, that of an air-fluid level in the pulmonary artery. This is pathognomonic of venous air embolism when the patient has a chest film made in the upright position.
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To determine the factors that allow early recognition of injuries to the intrathoracic and intra-abdominal organs in patients with penetrating wounds to the lower thorax and abdomen with site of entrance located in the back or flanks, we retrospectively analyzed the cases of 77 such patients. There were 65 stab wounds (85%) and 12 gunshot wounds (15%). The injuries were confined to the abdomen in 46 (60%); 39 were stab wounds and seven were gunshot wounds. ⋯ All of the seven thoracoabdominal injuries, two produced by gunshot and five by stabbing, necessitated celiotomy. Most patients with gunshot wounds to the back and flanks require celiotomy, but a selective therapy can be safely used in patients with stab wounds. The rate of negative exploratory celiotomy was less than 5%; the mortality was 1.3%.