J Trauma
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Blunt trauma to the chest may produce a spectrum of cardiac lesions extending from asymptomatic myocardial contusion to rapidly fatal cardiac rupture. A case is discussed in which a patient with signs of cardiac tamponade after blunt trauma was found to have a rupture of the atrium. During repair of the cardiac injury, an unusual tear of the right superior pulmonary vein was also discovered. Both injuries were successfully repaired and the patient recovered.
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The establishment of immediate venous access and rapid fluid administration remains of paramount importance in the treatment of hypovolemic shock. We describe a technique for placement of a recently available 10-gauge catheter via venous cutdown. ⋯ In addition, our studies show that the use of wide-bore intravenous tubing (urology irrigating tubing) instead of standard intravenous tubing allows for much higher infusion rates through the 10-gauge catheter. With the wide-bore tubing and pressure infusion, it is possible to administer 1,200 cc of blood per minute through this catheter.
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The mortality from abdominal vena cava trauma remains in excess of 33% despite advances in prehospital and intraoperative care. During the 7-year period ending December 1981, 58 patients with vena cava injuries were treated at our institution. Thirty-nine (67%) were due to gunshot wounds, nine to stab injuries, and ten to blunt trauma. ⋯ This contrasts to a 96% survival rate for the 28 patients without associated abdominal vascular injuries. Our experience underscores the importance of rapid resuscitation, early operation, and searching for associated vascular injuries before a time-consuming repair of the vena cava is undertaken. Improving the survival of patients with blunt retrohepatic cava and hepatic vein trauma remains a dilemma.
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In 5 years, 267 patients with cardiopulmonary arrest after trauma were treated at our institution. The long-term survival rate was 2.6%. ⋯ Overall, neither the mechanism of injury nor routine emergency thoracotomy influenced the salvage rate. Our results in the management of trauma victims without vital signs indicate that: 1) among blunt trauma patients, those with isolated head injury have the highest survival rate; 2) patients with blunt multisystem injuries involving the chest, abdomen, or truncal orthopedic structures are unsalvageable; 3) cardiopulmonary arrest with penetrating head or neck wounds is a lethal combination; and 4) with the exception of patients sustaining penetrating chest or heart injuries, emergency thoracotomy does not enhance the survival rate of trauma patients who were formerly declared 'dead on arrival.'
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An emergency splenectomy was necessary 25 days after blunt injury of a patient whose initial peritoneal lavage was negative, whose visceral angiograms were negative, and whose abdomen remained asymptomatic during interval intensive observations. Delayed splenic rupture can occur rarely in the face of extensive diagnostic evaluation.