J Trauma
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A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. ⋯ Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.
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Ninety-four cases of percutaneous tracheostomy and six cases of percutaneous cricothyroidotomy are reported in this study. There was one death attributable to the use of the device. A complication rate of 14% is reported. ⋯ Autopsies on 14 of these patients are discussed. Long-term followup, that is for 1 year and more, is reported in 19 cases. Advantages of the percutaneous technique over the standard dissection technique are detailed.
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From January 1982 through December 1983, 83 severely injured and hypovolemic patients were immediately resuscitated with uncrossmatched packed red cells. Seventy-four patients received 250 units (3.3 units/pt) of Group O red blood cells (TOB), and nine patients received 27 units of type-specific blood (TSB) (3.0 units/pt). Additionally, 53 units of TSB were transfused to the TOB group in the interval between TOB immediate transfusion and the availability of fully crossmatched blood. ⋯ Two patients developed positive hepatitis screens, and there was one clinical case of hepatitis observed. None of the 'DIC' cases were related to incompatible blood transfusion. We conclude that for immediate trauma resuscitation, TOB is safe and TOB has additional advantages over TSB or Type O whole blood transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Injuries to the larynx and cervical trachea are uncommon, making the development of treatment protocols and subsequent data analysis in any one hospital difficult. This prompted a review of our experience with emphasis on variables related to long-term morbidity. The records of 20 patients with laryngotracheal injuries seen at the Montreal General Hospital from January 1974 to December 1984 were reviewed. ⋯ Computerized tomography of the upper airway facilitates definitive surgical repair. Long-term followup is essential. Laryngeal trauma remains a major challenge.
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To assess the need for a trauma system in San Diego County, a concurrent audit of trauma care was performed by an independent consultant in 1982. During the study period from 15 March through 15 June 1982, 591 consecutive major trauma victims (MTV) were collected by the 30 participating hospitals. All medical records, including autopsy reports, were audited for the timeliness and appropriateness of diagnosis and definitive care. ⋯ The care of MTV was considered suboptimal in 32% of patients before regionalization, compared to 4.2% after regionalization (p less than 0.01). Preventable deaths occurred in 13.6% of fatalities occurring before implementation of a trauma system, compared to 2.7% after implementation (p less than 0.01). Regionalization of trauma care significantly reduced delays, inadequate care, and preventable deaths due to trauma.