J Trauma
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A motor vehicle passenger sustained an acute traumatic lumbar hernia caused by an improperly positioned seat belt. Diagnosis was confirmed on computed tomographic scan, and the defect repaired primarily.
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Three weeks after a shotgun wound to the chest and abdomen, a patient developed acute ureteral colic caused by a migrating shotgun pellet. The pellet passed spontaneously. A search of the literature revealed 25 similar cases of this unusual complication of missile injuries to the abdomen. ⋯ Cases involving bullets and shrapnel fragments usually have had long latent periods after the initial injury and required surgery to remove the obstructing projectile. In contrast, cases of "buckshot colic" from shotgun pellets present earlier and often resolve with spontaneous passage of the pellet. The following report illustrates how conservative management can be successful in cases of "buckshot colic."
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Traditional practice of mechanical ventilation includes tactics to reduce lung injury, such as avoidance of excessive airway pressure, patient distress, and tidal volume. Gas exchange objectives have received priority, however, and a degree of lung injury has been accepted as inevitable. The current trend toward increasing use of permissive hypercapnia is based on the recognition that lung injury induced by mechanical ventilation may be reduced by compensated hypercapnia with few serious adverse effects and contraindications.
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Neuroleptic malignant syndrome is a rare complication of antipsychotic medications. This paper describes the case of a trauma patient who received haloperidol and droperidol for severe agitation, developed neuroleptic malignant syndrome, and was treated successfully with dantrolene sodium, and also provides a review of the literature.