The Surgical clinics of North America
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Burns in the urban environment present special problems. Although there generally is ready access to appropriate care and short transport times, burn injury remains a serious concern. Inhalation injuries, electrical and chemical burns, and burns as a result of abuse or assault are common problems.
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Surg. Clin. North Am. · Apr 1991
ReviewPrinciples of ballistics applicable to the treatment of gunshot wounds.
Ballistics is the science of the motion of a projectile through the barrel of a firearm (internal ballistics), during its subsequent flight (external ballistics), and during its final complicated motion after it strikes a target (terminal ballistics). Wound ballistics is a special case of terminal ballistics. ⋯ A special consideration in these cases is their medicolegal aspects. At a minimum, the medical team receiving the patient should exert care not to destroy the clothing and in particular to cut around and not through bullet holes, to turn over to law enforcement officials any metallic foreign body recovered from the patient, and to describe precisely, or even to photograph, any entrance or exit wounds.
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Many problems may complicate the treatment of pelvic fractures. Thorough evaluation of the whole patient, all local structures, and the skeletal injury itself is essential. ⋯ Posterior shearing injuries are poorly stabilized by external fixation, and require additional treatment. Especially when significant deformity exists, or when the posterior injury is primarily ligamentous, open reduction and internal fixation are likely to be beneficial.
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In an effort to reduce the rate of nontherapeutic celiotomy yet avoid the possibility of missed injuries, surgeons are evaluating protocols for nonoperative management of abdominal trauma. Discussion of this controversial issue includes specific approaches to the diagnosis and management of splenic injury, gunshot wounds, and stab wounds.
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Surg. Clin. North Am. · Feb 1989
Pulmonary contusion. Evaluation and classification by computed tomography.
In thoracic trauma, as in all of medicine, diagnosis precedes therapy. Over the past 5 years, we have liberally used chest CT examinations to improve diagnosis in the severely injured patient. ⋯ Confidence in our method of quantitation has helped us to assess the severity of pulmonary parenchymal injuries. Correlation of the CT findings with histologic study has changed our concept of pulmonary contusion from that of interstitial disease to that of pulmonary laceration with blood pneumonia.