摘要:

Forty-five patients with snake bite were studied: 33 were classified nontoxic and 12 toxic. There were no deaths and four complications in the nontoxic group; two deaths and three complications in the toxic group. The data suggest that rapid recovery is generally to be expected in nontoxic patients regardless of the form of local therapy. The risk of antivenin complications outweighs the minimal therapeutic benefits when administered to most nontoxic patients. If nausea and vomiting are the only manifestations of systemic toxicity antivenin may not be necessary for rapid and complete recovery. The combination of hypotension and bleeding diathesis represents a particularly severe form of toxicity that may result in death if adequate systemic and supportive therapy is not rapidly instituted.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The vertebral injuries sustained by 13 survivors of four light-plane crashes were reviewed. Eight patients sustained major nonvertebral injuries. Eleven patients sustained 18 lower thoracic and/or upper lumbar fractures. Eighty-five per cent of the fractures involved T12, L1, L2, or L3. Seven patients sustained vertebral burst fractures; ten sustained vertebral flexion fractures. In nine patients these vertebral fractures had associated fracture-dislocations of the posterior pedicles. Eight of these nine patients (89%) developed neurologic deficits of the conus medullaris and/or cauda equina. The severity and time of onset of these neurologic deficits were similar for the occupants of each aircraft.Downward vertical deceleration and rotational violence were the dominant forces which inflicted the vertebral column fractures which resulted in neurologic deficits.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

This report presents data obtained in the care of 830 patients requiring assisted ventilation. When these patients were divided into groups by the severity of their respiratory failure as defined by the duration of ventilatory assistance (>48 hours, <48 hours) and level of positive end expiratory pressure (PEEP) required (>5 cm HoH, <5 cm HoH), it was found that evidence of concurrent bacterial infection was present in the majority of patients with severe respiratory failure. This finding could not be explained by infection acquired after the onset of respiratory failure. In addition, this analysis demonstrated the important association of active pulmonary infection with the occurrence of barotrauma in these patients. Case analysis of patients subjected to extracorporeal membrane oxygenation has led to the suggestion that underlying sepsis in patients failing to respond to conventional ventilatory assistance similarly limits the usefulness of membrane oxygenator support.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Drowning accounts for 32% of all pediatric accidental deaths in Dade County, Florida. Swimming pools, primarily home pools, are the most common site, 38%; followed by canals, 27%; lakes, ponds and rockpits, 13%; and the ocean and bay, 11%. The majority of drowning victims could not swim and were dead at the scene of the accident. Most pool victims were white, male, and 3 years old. Most victims were thought to be engaged in a non-pool related activity before the accident. Children who drowned in lakes, ponds, and rockpits, canals, and the ocean and bay were usually of school age and unsupervised. Black children had a higher rate of drowning than white children in these sites.Recommendations to prevent drowning: 1) Community education programs; 2) Safety fence around the perimeter of swimming pool; 3) Higher water levels in pools; 4) Investigation of “drown-proofing” instructions for preschool children; 5) Mandatory swimming and water safety instructions in public schools; 6) More supervised public swimming sites.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A statewide evaluation of major inpatient trauma treatment was completed demonstrating the relationship of emergency medical service categorization and quality of trauma care. Demographic and organ injury data provided guidelines for preventive and medical education emphasizing the need for more practical sessions. The differences between the review process of primary care physicians and specialists was also discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Septic shock and the formation of pulmonary edema were studied in 19 baboons. Four animals served as controls. Four were subjected to deep septic shock by infusion of liveE. coliand then deliberately killed while in deep shock. Four were subjected to septic shock, resuscitated with Ringer's lactate (RL), and then killed 1½ hours after resuscitation was started. Seven were subjected to shock and resuscitation attempted with Plasmanate (PL).Resuscitation with RL was successful for 1½ hours in all four RL-animals. Resuscitation with PL was successful for 1½ hours in three of the 7 PL-animals. There was an increased tendency for albumin to extravasate into the interstitium of the lungs after resuscitation. The amount of pulmonary edema, measured by both the thermodye technique and by analysis of post-mortem lung composition, was the same in animals resuscitated with RL and PL. Administration of pure colloid offers no protection to the lungs in resuscitating patients from septic shock.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Hypovolemia continues to be an important cause of death in patients who die as a result of vehicular trauma. Diagnosis and treatment of a series of 127 patients who died with blunt abdominal trauma from automobile accidents during 1969–1974 in Vermont are reported. The most frequent errors in the cases reviewed were failure to recognize and adequately treat hypovolemia, and to appreciate the urgent need for surgery. Death on the X-ray table while allowing persistence of hypovolemia was the common denominator in four of five victims who died of ruptured spleens in the emergency departments, after having arrived alive following vehicular trauma. Forty-seven per cent of all reported deaths in automobile accidents had blunt abdominal trauma. Of those with blunt abdominal trauma who arrived alive, 26% might have survived with appropriate treatment which should have been available.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Fifty-nine cases of traumatic ureteral damage are presented. Gunshot wounds comprise the majority (52/59). Need for a high index of suspicion and aggressive diagnostic measures is stressed. The effects of missile velocity on the ureter are noted. Prompt operative management is advocated: choice of procedure depends on the location of the ureteral defect. Urinary complications occurred in 11/59 (19%). Four complications resulted from operative techniques no longer recommended. The death rate of 10% is related to the high incidence (57/59) of associated visceral and vascular injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Significant coagulation and blood gas changes may occur with uncomplicated extremity fractures. To more accurately define the effect of therapy on these changes, a prospective study of 58 patients with uncomplicated fractures was undertaken. An initial group of 10 selected patients was studied to determine the changes with “standard therapy.” The remaining 48 patients were then randomized into five groups: control, increased fluid intake, increased glucose intake, aspirin, and massive steroids. The patients were studied on 5 consecutive days.Treatment of patients in the latter four groups with aspirin or steroids resulted in significant normalization of blood gases, coagulation proteins, and platelet numbers when compared to controls. These measurements in patients treated with fluid loading or increased glucose intake were not significantly different from controls.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

When burns complicate the management of an otherwise severely injured patient, modifications in treatment must be undertaken for both problems. The unique situation of this type of patient often requires the use of multiple therapeutic interventions which may differ from the usual. The use of controlled hypotension and aggressive surgical burn management was successful in allowing the postponement of vascular surgery in a young male patient with a traumatic aortic disruption and extensive burns resulting from a 60-foot fall and severe thermal burns.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID