Southern medical journal
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In a retrospective review of one year's experience in the management of neck trauma, 88 cases comprising 42 gunshot wounds, 29 stab or slash injuries, and 17 injuries by blunt trauma were reviewed. Multiple injuries were noted in all groups, but a higher percentage was found in the blunt trauma series. Anesthetic management is reviewed, and emphasis is placed on careful evaluation of the patient's airway, using physical and roentgenographic examination to plan adequate airway management.
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Southern medical journal · Sep 1979
Case ReportsRight-sided posttraumatic diaphragmatic hernia presenting as a coin lesion.
An unusual case of right-sided posttraumatic diaphragmatic hernia is described. Ten years after closed chest trauma a 51-year-old man presented with a coin lesion at the right lung base. Thoracotomy revealed a rounded ball of liver tissue protruding through a diaphragmatic tear.
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We reviewed the anesthetic management of all children admitted with laryngeal papillomatosis during a six-year period. This included 147 endoscopies on 16 patients, most referred with advanced disease after initial care in other hospitals. Onset of the disease before age 2 was associated with the most severe upper airway involvement. ⋯ Extubation under deep anesthesia after clearing the glottis of secretions was usually followed by smooth emergence and minimal airway difficulties. There was only one instance of postoperative stridor suggesting croup. A standard anesthetic approach can be recommended, on the basis of the experience in this series, but possible variations in technic are also discussed for particular clinical applications.
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Southern medical journal · Jul 1979
Metabolic alkalosis complicating weaning from mechanical ventilation.
Metabolic alkalosis was identified and confirmed as a precipitator of acute hypercapnea. As a result, weaning from mechanical ventilator therapy was delayed. Correction of alkalosis followed by reduction of PCO2 confirmed the compensatory mechanism during alkalosis, and weaning from intermittent mandatory ventilation then proceeded at an appropriate rate.
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Epidural blood patch should be considered the treatment of choice for postoperative headache if oral fluids and bed rest provide no relief. There should be no hesitation in performing this procedure, provided there are no contraindications. The two important contraindications are (1) evidence of inflammation or infection on the back when the puncture is to be made and (2) septicemia. A representative case is presented.