J Trauma
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Human burn injury is associated with an inflammatory response and related hyperdynamic cardiovascular profile. Increased production of nitric oxide (NO), a potent endogenous vasodilator, has been reported in patients with inflammatory states, including sepsis, but not after trauma other than burns. We studied whether plasma levels of the stable byproducts of NO, nitrite (NO2-) and nitrate (NO3-), are increased in burn patients. ⋯ Human burn injury is associated with an increase in NO production. In this small-size study, NO production was not proportional to burn area, and seemed to be further enhanced in septic patients.
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Perforations of the gastrointestinal (GI) tract, compared to solid organ injuries, are a relatively infrequent sequela of blunt abdominal trauma in children. The purpose of this study is to review retrospectively the diagnostic modalities used in 30 children with proven traumatic intestinal perforations treated at one institution. Since computed tomography with intravenous and oral GI contrast is commonly used in the diagnosis of suspected solid organ injury from blunt abdominal trauma, we evaluated retrospectively the computed tomographic (CT) scan findings in these children in an attempt to accurately predict or suggest GI perforation. ⋯ The CT scan may be a useful adjunct to the diagnosis of an intestinal perforation in patients who have no immediate indication for surgery. Presently, the only CT finding that is an absolute indication for laparotomy is free air (in the absence of pulmonary/mediastinal injury or barotrauma). The other CT "findings" need to be validated prospectively.
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We report a case of accidental severe hypothermia from cold exposure in a 31-month-old girl. The rectal temperature was 14.2 degrees C on presentation, and was accompanied by cardiac arrest. ⋯ An amputation of one leg was required, but neurologic recovery was full. We emphasize the importance of timely, aggressive management in victims of severe hypothermia because of the tremendous potential for salvage despite catastrophic presentation.
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Internal carotid arterial occlusion, being a rare occurrence following whiplash injury, is frequently missed. We report an unusual case of a 41-year-old woman driver who was involved in a head-on collision with a truck. ⋯ Subsequent investigations showed a right parietal lobe infarct and bilateral internal carotid arterial dissection. We conclude that acute whiplash injury can result in bilateral internal carotid arterial dissection and that clinicians treating these patients should be aware of this complication.
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Authors presented their own experiences in treating 735 wounded in high-intensity combat zones in the territories of former Yugoslavia during 1991 to 1992. The mobile field hospital with surgical crews was situated 5 to 10 km from the front line, and its basic task had been continuous triage, immediate resuscitation with vital surgical aid, as well as organization of adequate primary and secondary air evacuation. ⋯ Mortality at this primary level, field hospital was 0.75% with primary immediate resuscitation and 1.9% with immediate evacuation. We concluded that immediate resuscitation with delayed transport had advantages, compared with fast evacuation of only the wounded.