J Trauma
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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.
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Comparative Study
Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution.
Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. ⋯ In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.
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The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as "essential" for level I and II or "desirable" for level III trauma centers. ⋯ Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.
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Review Case Reports
Ipsilateral radial head dislocation with radial shaft fracture: case report.
An extremely rare injury, traumatic radial head dislocation with concomitant fracture of the radial shaft, is reported. The dislocated radial head could not be reduced by closed technique because of capsular interposition. Reduction of the radial shaft fracture was possible only after the dislocation of the radial head was reduced.
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The nail gun is a potentially dangerous device that is commonly used in the construction industry to drive various sizes of nails into wood or concrete. These devices appear to be used without sufficient training and they can be easily obtained by the general public. ⋯ We call for a review of operator training and the design of both the safety mechanism of nail guns and the protective clothing worn by operators. If necessary, modifications should be introduced to reduce the likelihood and severity of such potentially serious injuries.