J Trauma
-
The rural area is not immune to multi-casualty incidents, and the complete rural EMS System reported here includes a plan to deal with one. The Susquehanna Valley Health Care Consortium was developed with this in mind, and addresses the points pertinent to the rural setting, including the large area served, available medical care, prehospital transport, and communications. Six hospitals in five counties participate. New approaches to these problems, which emerged after three field tests, are: participants must be organized for successful triage and resuscitation; crowd and traffic control by police is mandatory; an overall commander is necessary; two-way communication by several methods must be available; an administrator should track all victims; and air evacuation capability should be arranged.
-
Between 1972 and 1981 40 victims of near-drowning were admitted to the Santa Clara Valley Medical Center. Hospital records were reviewed with regard to: 1) the circumstances of submersion and rescue; 2) the patient's condition upon arrival at the emergency room; 3) treatment, hospital course, and ultimate outcome. There were ten hospital deaths, 23 patients recovered completely, and seven were discharged with incapacitating neurologic disability. ⋯ The use of hypothermia, steroids, and barbiturate coma was not randomized, but did not appear to influence ultimate outcome. Intracranial pressure was monitored in five patients and was never elevated during the first 24 hours. The complete recovery of nearly 20% of apparently lifeless individuals justifies aggressive resuscitation and support of all victims of near-drowning.
-
Open pelvic fracture is a devastating injury with a reported 50% mortality rate from massive bleeding and pelvic sepsis. Utilizing a graded approach to management of hemorrhage that included wound packing, anti-shock trousers, angiographic embolization, and hemipelvectomy, we controlled bleeding in all but one of the 35 patients in this series. Patients lost an average of 15 units of blood. ⋯ Prevention of invasive infection by a diverting colostomy in patients with buttock wounds or perineal wounds was stressed, while anterior soft-tissue wound were managed selectively. Debridement and frequent dressing changes under anesthesia were necessary to prevent and/or treat soft-tissue infection. Associated injuries occur commonly with genitourinary and peripheral nerve trauma and account for the majority of the long-term morbidity.
-
Clinical research on burns has developed substantially in China since 1958. Having the rich inheritance of our traditional medicine the study of burn treatment in our country has developed in a way somewhat different from that in Western countries. ⋯ In the field of estimation of the surface area and depth classification, immunology and its clinical practice of skin graft, burn wound sapremia and burn septicemia, much clinical and laboratory research work was studied by the Chinese surgeons in the past 10 years. Also, prevention of scar overgrowth and deformity following its burn contracture by prophylactic management is discussed.
-
The pathogenesis, pathology, classification, clinical features and prognosis of pulmonary burn injury have been studied recently by Chinese surgeons. New methods to treat electrical contact burns and chemical burns are introduced in this paper. The initial attempt to use microvascular surgical technic for repairing the post-burned tissue defect has developed successfully in China.