J Trauma
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Case Reports
Superior laryngeal nerve block: an aid to intubating the patient with fractured mandible.
Awake nasotracheal intubation in the patient with a fractured mandible may be facilitated by combining bilateral superior laryngeal nerve block with topical application of local anesthetic to the nose, mouth, and trachea. Successful use of this technique is described in two such patients.
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A prospective study of post-traumatic fat embolism among a group of Chinese patients suffering from fractures demonstrated an incidence of 8.75% in fracture patients with overt clinical features and a mortality rate of 2.5%. In a multiple-fracture group the incidence of fat embolism was 35%. ⋯ The presence of large vacuoles in the cryostat sections is demonstrated and its significance discussed. The 'iceberg' phenomenon of fat embolism syndrome should be well recognized, particularly in patients with multiple fractures.
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In a 3-year period of prospective study, 250 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a modification of the Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except for neurologic injuries. Neurologic injuries are scored by using a combination of the Glasgow Coma Scale (GCS) and other neurologic findings (presence of surgical mass lesion, pupillary light response, and oculocephalic reflexes). ⋯ Mean MISS scores for death and disability were 33.4 and 30.2, respectively. Neurologic injuries were present in 173 patients (69%); 128 patients had severe head injuries (coma greater than 6 hours duration); 80% of all deaths were due to neurologic injury and all but two deaths had some degree of head injury; the remaining 20% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 73% mortality, while those with grades 4 and 3 injury had 8% and 2% mortality, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)