J Trauma
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Injury to the gallbladder following blunt abdominal trauma is an unusual finding at laparotomy, with a reported incidence of less than 2%. Avulsion from the liver and detachment from both the cystic duct and artery is an extremely rare finding. The condition of the patient and the extent of injuries will dictate the procedure performed. In the case presented, total avulsion of the gallbladder was successfully treated with identification and ligation of the cystic duct, and coagulation of small bleeding points, followed by placement of a Penrose drain.
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Shotgun wounds present specific challenges for the surgeon. Multiple penetrating wounds frequently involve large anatomic areas with potential multi-system injury. Experience with 121 patients sustaining shotgun wounds over the 5-year period ending 31 December 1981 was reviewed to assess results and evaluate treatment protocols. ⋯ Five had major vascular injuries. Preoperative arteriography was obtained in 13 patients with extremity injuries; the results of one of these were falsely negative. There were no deaths or amputations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study Clinical Trial Controlled Clinical Trial
Rapid volume replacement for hypovolemic shock: a comparison of techniques and equipment.
The achievement of a very rapid fluid infusion rate may be critical in the resuscitation of the patient in hypovolemic shock. We studied flow rates of crystalloid and whole blood through various intravenous catheters and tubing systems. The 10-gauge Angiocath and the 8 Fr pulmonary artery introducer catheter provide flow rates equivalent to intravenous tubing (3.2 mm I. ⋯ Substantially higher flow rates can be achieved with the use of large-bore intravenous tubing (5.0 mm I. D.) connected to these catheters in place of standard intravenous tubing, allowing the infusion of 1,200-1,400 cc/minute of crystalloid and whole blood into the patient in hypovolemic shock through one intravenous catheter. Clinical trials with larger bore intravenous tubing are probably indicated.
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Distal interphalangeal joint dislocations of the fingers are uncommon but easily reducible. Irreducible dislocations are quite rare and treatment of such a case is being reported here. Causes of irreducibility have been found to be: volar plate interposition, protrusion of the middle phalanx through the joint capsule, and flexor tendon displacement over the middle phalanx. When these situations occur open reduction is indicated.
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Objectives of temporary descending thoracic aortic cross-clamping for exsanguinating abdominal hemorrhage are to redistribute intravascular volume to the myocardium and brain, and to limit further blood loss. This report describes our experience with left thoracotomy and descending aortic occlusion (T/AO) performed in the operating room (OR) for massive hemoperitoneum. During a 5-year period, 39 (5%) of 791 patients undergoing laparotomy for acute injury required T/AO in the OR. ⋯ Only two patients, however, had pulmonary problems associated with T/AO; and both were minor (atelectasis and recurrent pneumothorax). In our experience, T/AO in the OR is successful in salvaging nearly one third of patients with life-threatening abdominal hemorrhage. The procedure can be performed rapidly, safely, and with minimal late sequelae.