J Trauma
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Survivors of innominate and other major cardiovascular injuries are being seen with increasing frequency. Penetrating injuries more frequently involve the distal innominate artery and innominate veins. Associated subclavian and carotid artery injuries are more frequent following penetrating trauma. ⋯ A variety of operative exposures is useful but the selection of incision frequently depends upon the presence or absence of associated mediastinal injuries. Partial or complete median sternotomy in combination with various cervical and thoracic extensions is advised. Successful management of innominate artery injury can be performed without the aid of cardiopulmonary bypass or arterial shunts.
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In 34 cases of cervical spine facet dislocation treated between 1975 and 1979, the dislocations were reduced by closed methods and immobilized in the halo thoracic brace. If closed reduction was unsuccessful, open reduction and fusion were performed. ⋯ Patients with facet dislocations and minimal neurologic injury are at risk of late instability following halo thoracic brace immobilization, and therefore open reduction and posterior cervical fusion may be advisable for them. However, surgical fusion carries a high incidence of long-term neck pain and stiffness, and is indicated only in patients at risk of developing late instability.
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Acute subdural hematoma (ASDH) due to ruptured bridging veins occurs under acceleration conditions associated with rates of acceleration onset. That this is due to the strain-rate sensitivity of these veins was confirmed in an experimental model of ASDH. ⋯ A mathematical model embodying the known mechanical properties of subdural veins was used to develop tolerance criteria for the occurrence of ASDH. This tolerance curve was consistent with the clinical and experimental data but differed from tolerances previously proposed for head injury.
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The rural area is not immune to multi-casualty incidents, and the complete rural EMS System reported here includes a plan to deal with one. The Susquehanna Valley Health Care Consortium was developed with this in mind, and addresses the points pertinent to the rural setting, including the large area served, available medical care, prehospital transport, and communications. Six hospitals in five counties participate. New approaches to these problems, which emerged after three field tests, are: participants must be organized for successful triage and resuscitation; crowd and traffic control by police is mandatory; an overall commander is necessary; two-way communication by several methods must be available; an administrator should track all victims; and air evacuation capability should be arranged.