J Trauma
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Medial dissection of the aorta after blunt trauma is a rare occurrence. We report the case of a 79-year-old woman injured in a motor vehicle crash who suffered an acute DeBakey type I aortic dissection.
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Scapulothoracic dissociation, although rare, causes significant morbidity and mortality by completely disrupting the attachments of the scapula to the axial skeleton with the skin remaining intact. The defining constellation of injuries is subclavian or axillary vascular disruption, lateral displacement of the scapula, separation of the clavicular articulations with or without fracture of the clavicle, and cervical nerve root avulsion or brachial plexus injury. Orthopedic stabilization, vascular repair, and brachial plexus exploration are mandatory. Above elbow amputation, either primarily or within 24 hours, is recommended for the flail extremity.
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This retrospective study of 100 consecutive patients with inhalation injury documents that adult respiratory distress syndrome (ARDS) and pneumonia are common complications. Pulmonary complications cause or directly contribute to death in 77% of patients with combined inhalation and cutaneous burn injury. Additionally, the high fluid requirements of these patients worsens their pulmonary injury and is associated with adverse outcome. ⋯ An abnormal chest roentgenogram in the first 48 hours after injury is also associated with death. The development of ARDS is predicted by the actual volume of fluid resuscitation, despite normal pulmonary wedge pressure or normal central venous pressure reflecting increased microvascular permeability. These findings indicate a need for reevaluation of fluid resuscitation of patients with inhalation injury.