J Trauma
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The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. ⋯ One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.
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Penetrating trauma of the neck has been divided into three anatomic locations. Zone III, the subject of this paper, is defined as the area between the base of the skull and the lower border of the mandible. Management of these injuries remains problematic. ⋯ An air embolism resulting in hemiparesis was the only complication of the angiographic studies. We conclude that angiography is essential in Zone III neck wounds. It facilitates triage decisions and, combined with transcatheter embolization, enables the majority of these injuries to be managed without surgical exploration.
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Trauma to the extrahepatic biliary tract is rare but, if overlooked or improperly managed, may be associated with significant morbidity. The following is our most recent 6-year experience with this unusual injury. Among 949 patients undergoing laparotomy for acute trauma, there were 32 (3%) injuries to the gallbladder and five (0.5%) to the common bile duct. ⋯ An intrapancreatic CBD lesion was managed by sphincteroplasty and stented with a T-tube. The one patient with complete transection underwent choledochoenterostomy. Postoperative complications were common (50%) but none were related to the biliary injury.