J Trauma
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Twenty-two patients were interviewed after lower limb amputation above the ankle joint following fractures. Their median age at the time of the injury was 44 years (range, 14-77 years), and median amputation delay was 2 months (range, 0-213 months). Of the 15 patients who were working before the injury, ten returned to gainful employment after amputation. ⋯ Twenty patients could walk outdoors; two patients aged 69 and 71 years could not, but regularly went outdoors using a wheelchair or a three-wheeled moped. Eleven patients were more or less dependent on help from others. The study indicates that most patients have an acceptable functional result, but with increasing age the chance of a return to employment decreases, and the need for help with everyday demands increases.
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The rapid treatment of patients with a severe head injury often includes prehospital intubation and sedation, but such measures compromise the ability to obtain an accurate Glasgow Coma Scale (GCS) score in the emergency department (ED). Major head injury centers in the United States were surveyed to determine how they currently obtain initial GCS scores when these or other complicating circumstances exist. A two-page questionnaire was distributed to seven members of the trauma team at 17 major neurotrauma centers in which they were asked who usually determines the initial GCS score, where they are assessed, and when. ⋯ Most neurosurgeons said that hypotension and hypoxia are stabilized before the initial GCS scores are assessed and that intubated patients receive a non-numerical designation. But the majority of non-neurosurgical ED personnel said that they determine the initial GCS scores immediately after arrival of the patients in their department, regardless of hypoxia or hypotension. There also were significant discrepancies between attending neurosurgeons and their residents with regard to who actually assesses the GCS scores and how the scores are determined for patients who have received neuromuscular paralysis or sedation or who have severe periorbital swelling.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Baluster entrapment avulsion of the little finger: a new clinical entity--case reports.
Five cases of avulsion injuries of the little finger are described. The mechanism of injury was identical in all cases. The little finger was entrapped by a baluster when the patient frantically attempted to grasp the handrail to avoid falling down stairs. To our knowledge, this type of injury has not been reported previously.
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Comparative Study
The role of echocardiography in blunt chest trauma: a transthoracic and transesophageal echocardiographic study.
Previous studies assessing the value of transthoracic echocardiography (TTE) in blunt chest trauma are limited because patients with severe chest wall injury often have suboptimal echocardiographic findings. Transesophageal echocardiography (TEE) can provide high quality images when the transthoracic image quality is poor. To provide complete echocardiographic assessment of cardiac structure and function we prospectively performed TTE in 105 patients with severe blunt chest trauma and TEE in 20 of the 105 patients (19%) whose TTE examination results were suboptimal. ⋯ We conclude that myocardial contusion is common following blunt chest trauma, rarely requires treatment, and is associated with a favorable prognosis. Only patients who develop cardiac complications benefit from echocardiography. Transesophageal echocardiography is of value when the TTE examination results are suboptimal and when aortic injury is suspected.
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Case Reports
Transesophageal echocardiography in the evaluation of a transmediastinal gunshot wound: case report.
Transesophageal echocardiography is a safe, minimally invasive imaging modality that may be useful in the evaluation of transmediastinal gunshot wounds. In this report, we describe a hemodynamically stable patient who sustained a gunshot wound to the ascending aorta. Routine diagnostic evaluation, including aortography, failed to confirm the suspected diagnosis. Transesophageal echocardiography definitively detailed the injury to the aorta enabling definitive surgical repair.