J Trauma
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During a 7-year period (1980-1987), 161 patients underwent emergency thoracotomy for penetrating lung injuries. Of these, 25 (15%) had injuries involving central pulmonary (hilar) vascular structures. Anterolateral thoracotomies were performed in 14 patients because of unstable vital signs (ten) or cardiac arrest (four), and only two (14%) of these patients survived. ⋯ Eight of the 14 deaths were clearly due to blood loss, which was treated with an average of 19.5 units of blood. However, in six of the earlier deaths with much less blood loss, air emboli may have been a factor, but was unproven. Early vascular control at the hilum for central lung injuries seems to be needed not only to stop the bleeding but also to prevent systemic air emboli.
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Chylothorax following blunt chest trauma is rare; we found only 19 cases reported. We describe an unusual patient with chylothorax from closed chest injury. ⋯ Thoracostomy in the definitive therapeutic modality. Nonoperative or, when necessary, operative treatment of chylothorax after blunt trauma can lead to a successful outcome in 90% of cases.
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A case with a "side-swipe" injury in the left elbow while projected out an automobile window, resulting in avulsion of the distal one third of the humerus and proximal two thirds of the olecranon, is reported. The bony defect was reconstructed by an endoprosthesis to preserve elbow function.
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A new method of reduction of dislocated shoulders used by the Eskimos in Greenland is described. The method was tried as first attempt of reduction on 23 consecutive acute dislocations in the emergency room of a central Copenhagen hospital. ⋯ Three dislocations required general anesthesia and two attempts were unsuccessful, but dislocations were reduced using other methods. The advantage of using the Eskimo method is: 1) it is simple and can be used by nonmedical personnel; 2) nontraumatic; and 3) needs no facilities.
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Comparative Study
Effect of helicopter transport of trauma victims on survival in an urban trauma center.
This paper reports a retrospective analysis of patients with serious yet substantially survivable injuries represented by ISS scores from 20 to 39 and whether or not survival was influenced by the use of helicopters. A review of 606 of these patients with blunt trauma was performed for the period from 1983 through 1986. When the group was evaluated there were 451 patients in the ISS cohort of 20-29 and 155 in the 30-39 group. ⋯ Overall the mortality for ambulance transported patients was 13% compared to 18% for the helicopter group. We conclude that there is no survival advantage in the helicopter transported group in an urban area with a sophisticated prehospital care system. Patients of rural origin deserve further study.