J Trauma
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The management of impaled foreign objects is always a challenge. Stabilization of the object, control of hemorrhage, and adherence to the basic principles of airway and breathing control are hallmarks of prehospital management. ⋯ A penetrating injury to the left hemisphere of the brain with a crowbar is presented. This case demonstrates the characteristics of these injuries in terms of extrication, assessment, management of complications, and neurologic sequelae.
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Forty intact cadaver elbows were studied to determine the contribution of the capitellum to elbow stability. With the elbow at 10 degrees of flexion, valgus motion of the elbow after capitellum excision demonstrated a minimal increase. Although some increase in valgus motion did occur after capitellum excision and radial head resection it was not until the ulnar collateral ligament was released that a severe valgus deformity was produced. ⋯ Followup at greater than 1 year utilizing various treatment modalities is reported. Although closed reduction gave the best result, acceptable results were also obtained by open reduction and internal fixation and excision. Our clinical findings corroborated the cadaver findings in that valgus instability of the elbow only occurred when fracture of the capitellum was associated with medial ligament injuries.
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In order to investigate the effect of positive pressure ventilation on vena cava blood flow, intraoperative manometric measurements were made in three patients with blunt abdominal trauma. These patients had intra-abdominal hemorrhage but no injury to the vena cava. The vena cava pressure increased with stepwise increases in the inspiratory pressure of the ventilator. The implications of this for the management of injuries to the inferior vena cava are: control of blood loss from caval wounds requires blockage of retrograde and antegrade caval blood flow; temporary cessation can stop retrograde caval flow from the right atrium and allow identification and repair of the caval defect; and retrograde caval blood flow can be used to flush out air bubbles and blood clots.
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Comparative Study
Comparison of blood serum iodine levels with use of Iodoplex and povidone iodine ointment.
Concentrations of iodine were assayed in burn patients, who were covered with Iodoplex ointment up to 30% of their body surface. The iodine levels in the serum were found to be in linear proportion to the area treated with an increase of 30 micrograms iodine per 100 ml of serum for 1% of TBSA. The maximal levels were reached within 24 hours of applying the Iodoplex ointment and decreased quickly following its discontinuation. Concentrations of the iodine were much lower than those found after treatment with povidone iodine, a fact which indicates that using Iodoplex in second-degree burns and donor sites entails fewer possible complications due to high levels of iodine in the serum than with povidone iodine.
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Cutaneous injury caused by exposure to gasoline and other hydrocarbons is a clinical entity with potentially life-threatening effects. We report four cases of such injury. One patient developed full-thickness skin loss following gasoline immersion, and another developed severe systemic complications following contact with a carburetor cleaning solvent. ⋯ In most cases this includes debridement, topical antimicrobial agents, and dressing changes. Severe pulmonary, cardiovascular, neurologic, renal, and hepatic complications may accompany hydrocarbon absorption, particularly in cases involving gasolines containing lead additives. Therefore immediate surgical debridement should be considered if there is suspicion of continued absorption of toxic compounds from the wound.