J Trauma
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The Boston Emergency Medical Service system was studied to determine the effects of Advanced Life Support (ALS) prehospital trauma care compared to Basic Life Support (BLS) treatment. The severity of injury and clinical status of patients was defined and monitored using the Trauma Score (TS) described by Champion. ⋯ Furthermore, a positive change in prehospital TS was significantly related to an increased chance of long-term survival for any given severity of injury (p = 0.0002). From these data we conclude that the TS is useful for prehospital triage and that appropriate field ALS resuscitation results in more favorable outcomes following major trauma.
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In a 3-year period of prospective study, 250 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a modification of the Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except for neurologic injuries. Neurologic injuries are scored by using a combination of the Glasgow Coma Scale (GCS) and other neurologic findings (presence of surgical mass lesion, pupillary light response, and oculocephalic reflexes). ⋯ Mean MISS scores for death and disability were 33.4 and 30.2, respectively. Neurologic injuries were present in 173 patients (69%); 128 patients had severe head injuries (coma greater than 6 hours duration); 80% of all deaths were due to neurologic injury and all but two deaths had some degree of head injury; the remaining 20% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 73% mortality, while those with grades 4 and 3 injury had 8% and 2% mortality, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Superior laryngeal nerve block: an aid to intubating the patient with fractured mandible.
Awake nasotracheal intubation in the patient with a fractured mandible may be facilitated by combining bilateral superior laryngeal nerve block with topical application of local anesthetic to the nose, mouth, and trachea. Successful use of this technique is described in two such patients.
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Soft-tissue injuries and defects associated with severe fractures of the tibia treated with the Hoffmann external fixator were reviewed. Of 84 cases of open tibia fractures (classified as Gustilo's Type II and III), 54 patients with 55 injured limbs required soft-tissue reconstruction other than skin grafts or small rotational flaps. These 55 cases were constructed with 37 local musculocutaneous flaps (20 gastrocnemius, 17 soleus and other smaller muscle flaps), 15 free musculocutaneous flaps (14 latissimus dorsi, and one tensor fascia lata), and three medial gastrocnemius cross leg flaps. ⋯ There was a nonunion rate of 25.45% (14 cases) at 18 months postinjury. The Hoffmann external fixator has allowed bony stabilization and has not precluded the subsequent soft-tissue reconstruction or bone grafting. Muscle and musculocutaneous flaps, both local and free, have been employed in the reconstruction of the leg with minimal interference from the Hoffmann device.
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The mechanism of upper extremity trauma in three patients from a round hay baler is analyzed in relation to previously described experimental models of wringer or roller injury. One patient sustained an avulsive injury with typical tearing of the soft tissues. Thermal insult from roller friction heat and the duration of exposure were significant factors determining the extent of tissue injury in the other two patients.