J Trauma
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Synthetic Adhesive Moisture vapor permeable (S. A. M.) dressings, Op-Site and Tegaderm, are compared to Fine Mesh Gauze (F. ⋯ M. dressings and scalp as a donor site allows for rapid reuse of a donor site. Pain is substantially decreased and rate of healing is increased when this combination is used. The scalp, because of its availability, accessibility, excellent color match for facial grafting, and rapid healing, is recommended as a donor site.
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Cricothyroidotomy is an excellent emergency procedure for airway obstruction which cannot be relieved by oral or nasal intubation. Important factors for a device for emergency cricothyroidotomy include selective airways, an airway lumen of sufficient size to permit suctioning or adequate airflow during spontaneous breathing, and the ability to assess depth and angle of penetration. An instrument that is simple to insert, offers protection against overpenetration, minimizes bleeding, and provides an airway offering a variety of lumens is described. It appears to provide an ideal means of accomplishing an emergency cricothyroidotomy for airway obstruction.
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Management of the pediatric patient sustaining a traumatic injury is influenced by patient size, surface area to body mass ratio, thermoregulation, and fluid requirements. A predetermined and systematic approach to the injured child guarantees recognition of life-threatening injuries and provides a method for rapid stabilization. The algorithm is divided into two distinct phases: life support and post-stabilization. The unique aspects of care of the injured child are highlighted to emphasize the significant differences in resuscitation and diagnosis from that of the adult patient.
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One hundred consecutive patients with 144 digital amputations performed at the University of Colorado Health Sciences Center between 1978 and 1980 were retrospectively reviewed. In this group, four patients demonstrated painful amputation stumps. Two of these were treated by surgical excision of neuromas and two patients, who had more vague complaints, were treated by desensitization which decreased the sensitivity of their stumps and allowed them to return to work. It is felt that this low incidence of painful neuromas and amputation stumps is due to the positive postoperative effort to send patients back to work as soon as possible, allowing them to perform their own therapy and thereby minimizing their disability and tendency to develop pain problems.
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Thirteen cases of jejunal perforation from blunt trauma are presented. There are no reliable signs or symptoms, and a normal physical examination may be seen. Free intraperitoneal air on plain radiograms is characteristically absent. ⋯ Mortality is usually associated with other serious concomitant injuries, and complications are associated with diagnostic delays. Diagnostic peritoneal lavage is a safe and reliable procedure for establishing an early diagnosis of serious intraperitoneal injury. Its routine use in all cases of serious blunt abdominal trauma is advocated.