J Trauma
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A child with 12% total body surface area superficial and partial-thickness burns was admitted to the Oregon Burn Center. Within 48 hours of admission, signs and symptoms of toxic shock syndrome (TSS) were present including high spiking fevers, vomiting, diarrhea, hypotension, conjunctival hyperemia, and a diffuse macular erythroderma. ⋯ This strain has been shown to produce staphylococcal enterotoxin B (SEB). This case appears to be the first reported of toxic shock syndrome in a burn victim caused by staphylococcal enterotoxin B.
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Scapular fractures in the multiply injured patient have received little attention. Fifty-six patients with 58 scapular fractures secondary to blunt trauma were reviewed. The patients averaged 3.9 major injuries excluding their scapular fractures. ⋯ Eight patients died (14.3%). Although no patient died from the scapular fracture, half of the deaths in this series were the result of pulmonary sepsis arising in an associated ipsilateral pulmonary contusion. Scapular fractures provide the trauma surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated injuries of major consequence to the ipsilateral lung and chest wall, the ipsilateral shoulder girdle, and the ipsilateral subclavian, axillary, or brachial artery.
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Sixteen dogs were placed under general anesthesia and flail segments of the left chest were created by transecting ribs 7,8,9, and 10 anteriorly and posteriorly. Fractures were 10 cm apart so that a 10-cm flail segment encompassing four ribs was created. In Group I, the control (N = 5), the chest wall muscles were closed without any stabilization of the fractures. ⋯ The study established a canine model for flail chest. It also showed that strut stabilization of rib fractures with bone grafts promotes better healing than suture stabilization. It suggests that using bone grafts taken from another rib to stabilize flail segments may be unsatisfactory since the rib used as a donor showed no signs of regeneration at 30 days.
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Victims of traumatic asphyxia syndrome were studied to determine: mechanism of injury, severity of injury, characteristic physical stigmata, treatment, and long-term disability. Consecutive patients who sustained severe crush injuries with traumatic asphyxia in the 5-year period ending November 1984 were reviewed. Followup was established by personal examination or questionnaire. ⋯ Despite severity of injury, no long-term disability was detected at an average followup of 4.4 years. No long-term survivors demonstrated residual cyanosis, petechiae, swelling, or neurologic sequelae. All had returned to work or school.
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The selective management of penetrating neck trauma implies an attempt to individualize care and minimize unnecessary surgical exploration. In asymptomatic patients, diagnostic studies are performed in an attempt to exclude clinically unrecognized injuries. ⋯ However, only five patients (9.4%) actually benefitted from ancillary diagnostic studies, in that angiography documented clinically unrecognized injury. In an effort to avoid the indiscriminate use of ancillary diagnostic studies, a selective management plan based on anatomic zones of injury is provided.