J Trauma
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In order to quantitatively investigate the usefulness of intraosseous fluid and drug administration as a resuscitative modality, we studied the infusion flow rates of crystalloid solutions obtainable at varying infusion pressures into the bovine tibial medullary cavity and time to initial as well as 90% of maximal effect of intraosseously administered vasoactive drugs. Mean infusion rates +/- SEM (n = 6) at 300, 200, and 100 torr and atmosphere + 81 cm H2O were 41 +/- 2, 32 +/- 1, 27 +/-2, and 10 +/- 1 ml/min, respectively. The mean time (+/- SEM) to initial effect of intraosseous injections (n = 6) of either 0.5 mg epinephrine or 50 mg ephedrine was 17 +/- 3 seconds and mean time to 90% of maximal effect was 45 +/- 5 seconds. These results provide a quantitative basis for resuscitation by fluid and drug administration via the tibial malleolar intraosseous route and suggest that when performed in appropriate situations, the technique may have clinical utility.
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A case of crush injury to the lower extremities of an ironworker involved in the demolition of a bridge is presented. Extrication of the entrapped limbs was complicated by weakening of the bridge support due to acetylene torch cutting. After 3 hours the decision was made to complete the traumatic disarticulation of the right knee on site. Essential elements in the successful completion of such field intervention are presented and the unusual features of the case are emphasized.
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Records of 373 patients with penetrating wounds of the lung seen at the Ben Taub General Hospital over a 1-year period were reviewed. Intercostal tube thoracostomy was the only therapy required in 282 patients. Thoracotomy was performed in 91 patients with repair of a pulmonary lesion in only 45 patients. ⋯ Penetrating lung trauma in the majority of patients may be treated conservatively with a low incidence of infection or complication. Of the patients who require thoracotomy, associated injuries will frequently represent the major operative indication. Early thoracotomy for complication of clotted hemothorax or empyema is encouraged.
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A case of false aneurysm of the common carotid artery after blunt trauma is described. We found seven other such cases in the literature. The literature is reviewed and it is concluded that this rare injury should be operated on as soon as the diagnosis has been made. Lateral excision and arteriorrhaphy, or aneurysm resection in larger lesions, are recommended.
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This article reviews the literature on accidental injury in childhood, summarizing incidence rates and outlining the factors which have been cited as affecting pediatric trauma: the host, the agents, and the environment. During childhood, age and sex differences for rates of accidental injury are frequently reported. Vehicular accidents, falls, drownings, burns, and ingestions are found to be common agents of injury to pediatric patients. The home affords a virtual breeding ground for accidents to children; however, parents also play an important role in the child's environment, with their illnesses, preoccupations, or dispositions to (in)action having consequences which may eventuate in injury.