J Trauma
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Massive wound edema after a burn may impair healing and help to convert partial to full-thickness injury. Cold treatment (usually by immersion) has been reported to decrease wound edema and is useful in first-aid treatment of burns. Reliable quantitative data have been lacking and frequently a superficial burn has been studied. ⋯ Immediate application of cold by immersion in 15 degrees C saline for 30 minutes reduced the edema of a deep second-degree burn and did not impair resorption rate compared with control limbs, fluid content returning to baseline after 1 week. Cold treatment beginning 2 minutes after the burn did not decrease edema formation and did impair resorption. Fifteen per cent of the edema fluid was still present 1 week postburn, suggesting further injury to the burn wound vasculature with use of cold immersion 2 minutes postburn.
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Case Reports
Lethal complication from insertion of nasogastric tube after severe basilar skull fracture.
An unusual complication is presented arising from the use of a nasogastric tube in a patient with a massive basilar skull fracture. Intracranial passage of the NG tube resulted. Therefore, in the presence of a severe basilar fracture and/or significant maxillofacial trauma where the integrity of the base of the skull may be in question, one should be very hesitant to insert tubes into the nasopharynx.
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In hot climates, only high temperature fluids (are greater than 100 F) may be available for treatment of blood loss shock in combat casualties. Can the hot fluid be used safely and effectively? We compared hot Ringer's lactate (51.7% C/125 F) resuscitation (n=10) to body-temperature (100 F) fluid resuscitation (n=10) in a hemorrhagic shock dog model. ⋯ All animals in both groups survived. These findings suggest that battlefield use of hot fluids in controlled amounts can be safe and effective for treatment of blood loss shock in human combat casualties.
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The rarity of triceps tendon avulsion is called into question by our series of 6 cases collected over a 5-year period in a small, isolated Israeli community. The even rarer occurrence of triceps avulsion accompanying fractures of the radial head is more obviously contradicted by the 3 or 4 instances of such combined injuries in our series. ⋯ Just as fractures of the proximal ulna oblige the clinician to look for dislocations of the radial head (Monteggia or Hume fractures) (6), so must falls on the outstretched arm bring to mind the possibility of triceps tendon tears. Seemingly trivial findings then become significant, and the clinical entity thus crystallizes into the diagnostic syndrome.
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An unusual case of abdominal impalement is presented. In such patients intra-abdominal injury must be suspected, and the impaling object must not be manipulated until the proper moment in the operating room. An approach involving various subspecialties, such as urology, neuro-, and vascular surgery, is often required.