American journal of surgery
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The clinical value of an elevated white blood cell (WBC) count on a diagnostic peritoneal lavage (DPL) performed in an asymptomatic patient with a penetrating abdominal stab wound is controversial. ⋯ Patients lavaged at a mean 6 to 7 hours after an abdominal stab wound will have a significant incidence of false-positive studies based on an elevated WBC count alone. Lavage WBC counts > 3,000/mm3, particularly when associated with a serum WBC count > 11,000, are likely to be true positives and to indicate injury to the GI tract.
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Computed tomography (CT) is an important diagnostic modality in the evaluation of blunt head and abdominal injuries, but it has not been routinely used to evaluate blunt chest trauma. ⋯ Although CXR is less sensitive in detecting parenchymal and pleural injuries than CT, the majority of the injuries identified by CT alone are minor and require no treatment. CXR remains the primary modality for diagnostic evaluation of blunt thoracic trauma.
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Myocardial contusion is commonly diagnosed following blunt chest trauma, and has potentially lethal complications. Cost-effective case management in patients with suspected myocardial contusion is confounded by the low incidence of complications and the lack of a reliable test to predict them. The clinical usefulness of elevated cardiac enzyme levels is controversial. ⋯ Cardiac enzyme determinations have no useful role in the evaluation of patients with suspected myocardial contusion. They should be eliminated from current practice guidelines.
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Clinical Trial
Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung.
The operative management of penetrating lung injuries includes oversewing of small lung lacerations (pneumonorrhaphy), wedge resection, or anatomic resection. There are penetrating injuries of the lung for which oversewing of entrance and exit wounds will predispose to intrapulmonary hematoma or pulmonary venous-systemic air emboli, yet for which formal resection would be time consuming. The technique of pulmonary tractotomy with selective vascular ligation was developed in parallel with hepatotomy for liver injuries. ⋯ Pulmonary tractotomy is a straight-forward procedure that controls deep hemorrhage from lung injuries and may obviate the need for formal resection.
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Associated injuries and central nervous system (CNS) trauma are historically associated with poor outcome in patients with pulmonary contusions, but the value of specific factors reflecting shock, fluid resuscitation requirement and pulmonary parenchymal injury in predicting mortality in this population is not well established. ⋯ Outcome in patients with pulmonary contusion is dependent upon a number of variables including the severity of pulmonary parenchymal injury as reflected in PaO2/FiO2 ratio.