摘要:

The physical factors responsible for injury following an explosion in a room or building are: direct exposure to overpressure; blast-induced whole body displacement; impact of blast-energized debris; burns from flash and hot gase. The patterns of injury seen in the casualties from four terrorist bombings are described to illustrate the types and severity of particular wounds. The most common fatal injury is brain damage; ‘blast lung’ is uncommon in civilian terrorist bombings; flash burns, fractures, serious soft-tissue damage, and eardrum injuries are seen in people close to the bomb, who usually require hospital admission; many others taken to hospital can be treated for injury by debris and released. The environment and its internal structure and the position of the occupants of the space can influence the type and severity of injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Previous investigations have reported an 11 to 71% incidence of pulmonary edema following CNS injury, based on post-mortem examinations. No premortem assessment to date has been made of the frequency and severity of in vivo pulmonary fluid accumulation following acute head injury.The thermal green dye technique was used to objectively determine extravascular lung water (EVLW) in 18 comatose patients with severe acute intracranial injuries resulting from trauma or spontaneous subarachnoid hemorrhage. Patients with aspiration, lung contusion, or pneumonia were excluded from the study. Control values for EVLW were obtained on admission from a group of 13 traumatized patients without head injury or evidence of pulmonary disease or injury. Intracranial injury patients who had EVLW values greater than two standard deviations above the control group mean were considered to have pulmonary edema. The incidence of pulmonary edema in this series was 50% (9/18). Extravascular lung water was determined post mortem in five patients using the gravimetric method of Pearce.The results suggest that pulmonary edema is a distinct clinical event occurring frequently after acute intracranial injury. Edema appears to be mediated by increased pulmonary microvascular permeability, and is not primarily dependent on postinjury changes in intracranial pressure or pulmonary vascular pressures.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred eighty individuals are known to have jumped or fallen from Seattle's Aurora Bridge during the past 49 years. The survival rate has been increasing, as has been the severity of injury experienced by the survivors. Both prehospital resuscitative measures and advances in the overall care of the trauma patients in hospital may have contributed to this. The survival statistics and injury severity scores of this homogeneous group of patients before and after the institution of a sophisticated prehospital emergency medical care program (Medic I) provide historically controlled data on the role of this type of system in the care of trauma patients.More patients who were alive at the scene arrived at the hospital alive after the development of the Medic I program. Overall survival was tripled. Patients with more severe injuries survived.These data demonstrate that prehospital airway control, ventilation, initiation of fluid resuscitation and cardiovascular support by physician-supervised paramedical personnel can significantly benefit multiple trauma patients. In this context, the Medic I approach was superior to the previously existing ‘load and go’ system.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This study reviews the recent experience with popliteal artery injuries at the Massachusetts General Hospital. Twenty-two patients suffered 24 injuries. The overall limb salvage was 83%. Blunt trauma accounted for 19 of the cases and was associated with femur fractures, knee dislocations, and tibia-fibular and pluteau fractures: four amputations (21%) resulted. There were five penetrating injuries from three gunshot wounds, one stab wound, and one laceration: no amputations occured. The major factor in the amputated limbs was delay in diagnosis and therapy of the arterial injury associated with blunt trauma. Arterial disruption secondary to penetrating injuries was recognized more quickly and had a better outcome. A higher index of suspicion in blunt trauma may improve results. Recommendations for therapy are: arterial reconstruction should generally precede orthopedic operation. Venous ligation was not associated with increased limb loss, but we recommend repair if possible. Arterial repair includes thrombo-embolectomy in distal arteries. If necessary, reverse saphenous vein is grafted. When operation is unsuccessful, revision should be performed.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A series of 33 cases of Grade II and III open tibia fractures were treated with local wound care followed by application of the A-O external fixator. Two transfixing Steinmann pins were usually used above and two below the fracture site. In six cases one Steinmann pin and one anteroposterior Schanz half pin above and below the fracture were combined with a triangulated frame. Additionally, minimal internal fixation with lag screws was used in five cases.Union was achieved in 83% of tibiae in an average time of 9.9 months. Union occurred faster when the fixator was removed in less than 3.5 months but then the incidence of malunion tended to rise. Three patients required early amputation. Eleven tibiae developed deep wound infections. Knee function was well preserved but ankle function was often impaired.The A-O fixator performed as a useful, simple, stable, light weight and versatile system in the care of these Grade II and III fractures. However, many problems intrinsic to the open tibia fracture remain.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Gas gangrene is not a disease of the past. Despite improved awareness, earlier care of trauma victims, new antibiotics, and advanced monitoring techniques, histotoxic clostridia continue to cause loss of life and limb. A 20-year literature review on gas gangrene (Part I) indicates that a combined therapy approach with early recognition, surgical intervention, appropriate antibiotics, and hyperbaric oxygen (HBO) provides optimal care.Part II, a 15-year clinical experience, appears to be the largest English-language series reported using the combined therapy of antibiotics, surgery, and hyperbaric oxygen.One hundred thirty-nine patients (95 males and 44 females), average age, 38 years, were admitted with clostridial myonecrosis. Sixty-seven were in shock at admission and the 27 deaths occurred in this group. One hundred twelve patients (81%) survived the infection. There was a 5% mortality in post-traumatic extremity clostridial myonecrosis. Age and concurrent disease increased the mortality rate, as did delay from time of diagnosis to aggressive combined treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Compared to nonoperative treatment with silver sulfadiazine cream, early excision and grafting of 22 patients with indeterminant burns of less than 20% TBSA resulted in an average shorter hospitalization, lower cost, and less time away from work than 25 patients treated nonoperatively. While early excision and grafting resulted in increased use of blood products and operating room facilities, this did not result in increased patient morbidity. Long-term followup demonstrated no difference in need for reconstruction, incidence of blisters, incidence of loss of motion, or contour irregularities. Those patients treated nonoperatively required more late grafts for closure and demonstrated more hypertrophic scarring. Those treated by early excision demonstrated more mesh graft irregularity.We conclude that in otherwise healthy patients with dermal burns of indeterminant depth less than 20% total body surface area, early excision and grafting is the preferred form of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In the present investigation, we found that the catechol-O-methyltransferase activity (COMT) in erythrocytes of persons with severe thermal injury was strikingly increased when compared with that in erythrocytes of noninjured individuals. The specific activity of COMT in erythrocytes of burned patients was not correlated with extent of burn. Thus the echinocytes of burned persons are another example of abnormal red cells in which COMT activity is increased. This appears to be the first example of increased COMT activity in abnormal erythrocytes that is not associated with large numbers of reticulocytes.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Seatbelts were incorporated as standard equipment for automobiles constructed in North America in 1964. The first seatbelt law was made mandatory in Canada as of 1 January 1971. Between January 1976 and January 1980 38 patients involved in automobile accidents while wearing passive restraints were treated at I'Hopital du Sacré-Coeur: 32 of these 38 patients had signs and symptoms of abdominal injury. These patients wearing passive restraints had an unusually high incidence of gastrointestinal injury in comparison to previously reported patients not wearing restraints. Twenty-seven of the 32 patients had injury to the bowel or the bowel mesentery. This different spectrum of injuries is most likely related to the altered physics of rapid deceleration caused by restraint with the lap belt and shoulder harness.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We report a 13-year-old male who sustained a segmental injury to the third part of the left axillary artery following a subcoracoid shoulder dislocation while wrestling. The artery was repaired with an autogenous saphenous vein interposition graft. The patient's postoperative course was uneventful, and, in a 3-year followup, he has complete range of motion of the left shoulder without neurovascular compromise.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID