J Trauma
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Case Reports Comparative Study
Computed tomography of the pelvis in patients with multiple injuries.
The extent of osseous pelvic injury in patients suffering multiple organ trauma is difficult to assess. However, accurate information is essential in order to determine an acceptable treatment regimen, either operative (external or internal fixation), or nonoperative (bed rest and early ambulation). Twenty consecutive patients were treated for pelvic fractures from January 1981 through February 1982. ⋯ X-rays was demonstrated in these 13 patients. Six patients underwent operative intervention, four with Hoffmann frames (external fixation), and two with reduction and internal fixation. CT examination of the pelvis provides a rapid and thorough evaluation which is extremely useful in demonstrating all the fractures of the pelvis on the single examination, thereby allowing the early determination of the best treatment plan for patients with such major injuries.
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Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. ⋯ CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma.
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The Esophageal Obturator Airway (EOA) has been considered an effective ventilatory technique for cardiopulmonary resuscitation; however, few studies of its field effectiveness have been performed. We evaluated the EOA in 158 cases of prehospital cardiac arrest resuscitated by EMT II personnel utilizing the EOA for airway maintenance. The time of insertion from arrival of the unit and the number of unsuccessful attempts were recorded. ⋯ There was marked improvement in all parameters following ET intubation. The EOA presents technical problems which make it inferior to ET tubes in resuscitation of individuals in the field with cardiac arrest. Close monitoring of its use should be undertaken in areas where it is the primary method for airway maintenance.
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From 1977 to 1980 fixation with an external fixateur was performed in 33 injuries of the upper extremity: ten fractures of the hand, 22 Colles' fractures, and one osteotomy for Madelung's deformity. Application was primary in 19 patients and after another type of fixation (cast or Kirschner wire) had failed to hold reduction in 14 patients. All ten hand fractures healed in 4 to 12 weeks, and the distal radius fractures united in 6 to 10 weeks. The external fixateur for unstable fractures of the hand and wrist with bone or soft-tissue loss provides rigid skeletal stabilization, accessibility for wound care, and early joint mobilization.
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Clinical features of tibial and peroneal artery injuries are characterized in a review of 51 patients with 82 injured arteries. Injuries were penetrating in 34 (67%) patients and blunt in 17 (33%). Physical findings suggested arterial injuries in 42 (82%) patients, but nine had no signs of vascular trauma. ⋯ Amputations were necessary in eight (16%) patients. Limb loss was more frequent with blunt trauma (23%), shotgun wounds (33%), initial absent pulses (32%), and three injured vessels (60%). The frequency of limb loss with these injuries emphasizes the importance of early diagnosis, expedient operation, and thorough revascularization.