J Trauma
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The cases of 60 patients with 63 open femoral fractures treated by primary reamed intramedullary nailing were retrospectively reviewed. Twenty-two were classified as Type I open fractures, 26 as Type II and 15 as Type III open fractures by Gustilo's classification. All fractures were treated by wound debridement followed by immediate reamed intramedullary nailing. ⋯ There were three nonunions and seven malunions. All of the complications were dealt with effectively by standard methods. We concluded that primary reamed intramedullary nailing is an effective alternative for the treatment of Type I and II open femur fractures and for Type III open femur fractures associated with multiple trauma.
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Over a 54-month period 6,142 patients were consecutively admitted to our Level I trauma center. Ninety-two blunt trauma patients required massive transfusion (MT) of 20 or more units of packed red blood cells (range, 20-126). Eighty-two per cent of all transfused blood was given within 24 hours of admission. ⋯ Thirty-two patients (74%) returned to work. We conclude that: 1) blunt and penetrating trauma patients receiving MT have similar survival rates of 50%; 2) shock, closed head injury, and age predict increased mortality but do not preclude survival; 3) long-term outcome in blunt patients requiring MT is excellent. Post-discharge death is rare and 3/4 of the survivors return to work, justifying the high cost of acute care.
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This report describes a case of bullet fragment embolus to the heart following a small-caliber gunshot wound to the mouth. Skull and C-spine films appeared to account for the projectile; however, chest X-ray followed by fluoroscopy and two-dimensional echocardiography demonstrated a venous missile embolus in the right heart. The bullet was palpated, trapped in the right ventricle, and easily extruded.
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Increased fuel economy and reduced injuries have been portrayed as incompatible goals, based on the false assumption that vehicle weight is the determining factor in both. Physics predicts that size and velocity, not weight, are the primary factors affecting crash forces, while increased weight or increased velocity consumes more fuel. ⋯ Fuel use is a function of weight and horsepower. Injuries and fuel use can be reduced by reducing vehicle horsepower without changing vehicle size.
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Heat loss leading to hypothermia is common during surgery, particularly when a body cavity is exposed. To determine the principal site of heat loss we used heat flux transducers to measure heat loss from the skin and the exposed abdominal cavity of seven pigs. Heat loss from the skin was 74 +/- 15 W/m2, and from the abdominal cavity, 350 +/- 122 W/m2 (p less than 0.002; ratio = 1:4.7). ⋯ Therefore adequate insulation would reduce the incidence of hypothermia. Evaporation accounted for the largest heat loss from the abdominal cavity. Evaporative losses could be minimised by enclosing the bowel in a plastic bag.