J Trauma
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In war, uncomplicated penetrating injuries to limbs require evacuation to a surgical facility. A delay is inevitable between injury and definitive surgical treatment. This paper describes an experimental model that has been developed to assess the efficacy of antibiotics in such war wounds; the aim is to develop a treatment protocol to prevent the development of infection before casualties reach a surgical facility. ⋯ If the start of treatment was delayed to 6 hours after injury, this treatment regimen was adversely affected by the introduction of only 10(3) S. hyicus. In conclusion, an intramuscular benzylpenicillin regimen, commenced 1 hour after wounding, can prevent infection in penetrating soft tissue missile wounds for up to 3 days. A delay of 6 hours renders treatment ineffective.
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It is known that blast wave and fragments are the primary causes of casualties from explosive weapons. To study the characteristics of blast-fragment combined injuries, functional and morphological changes were investigated in three groups of anesthetized dogs with blast injury, high velocity fragment extremity injury, and combined injuries of both types. The same parameters were also examined in a control group. ⋯ It is concluded that extremity injury from high velocity fragment will aggravate lung blast injury. Changes in the levels of PGI2 and TXA2, can be used to determine the extent of injury in the three kinds of wounds. This may be useful for early diagnoses and rational treatment of the victims of explosion.
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Review Case Reports
Nonoperative management of a splenic tear in a Jehovah's Witness with hemophilia.
Splenic laceration, the most common visceral lesion following blunt abdominal trauma, can be treated in a nonoperative fashion in only a select group of stable patients with minimal injury. We report a unique case of life-threatening splenic trauma in a Jehovah's Witness with hemophilia that was successfully managed without surgery.
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The inability to normalize lactate predicts death after trauma, but lactate may not be immediately available in every center. We postulated that, in a normal acid-base environment, lactate would correlate with the anion gap and the base excess of an arterial blood gas. ⋯ There is no correlation between lactate, base excess, and anion gap after initial resuscitation. Neither anion gap nor base excess was capable of predicting lactate; therefore, lactate must be directly measured. The lack of correlation of anion gap with base excess or lactate suggests the presence of unmeasured anions, an impairment in acid-base regulation after injury and resuscitation, or both.