J Trauma
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Case Reports
Traumatic intramyocardial dissection secondary to significant blunt chest trauma: a case report.
The case of a patient with delayed mitral regurgitation and right coronary artery traumatic injury in association with intramyocardial dissection without rupture or pseudoaneurysm is presented. These findings evolved secondary to blunt chest trauma and were confirmed by cardiac ultrasound scanning, magnetic resonance imaging, and cardiac catheterization. Successful surgical correction was facilitated with this combination of diagnostic testing.
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The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. ⋯ Annual medical cost of all admissions including rehabilitation, however, could be as great as $12 million for the Medical Center and $53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Major blood loss occurs with excisional therapy of burns. To our knowledge no studies have quantitated blood loss in pediatric patients. This prospective study was performed to analyze blood loss in a pediatric burn population undergoing excision and grafting. ⋯ Assessment of losses by age and depth of wound, patient age, and anatomic site showed no differences between these groups. Tourniquets lowered intraoperative losses but had no effect on overall losses. The value of knowing blood losses precisely is evaluated in terms of efficiency of ordering blood.
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This study was initiated to investigate the need for routine pelvic roentgenograms for all blunt trauma victims. Over a 2-year period, we prospectively studied patients referred to the trauma service in the level I trauma center at our institution who met the inclusion criteria. ⋯ All 125 patients included in the study were found to have normal results on pelvic roentgenograms. We conclude that alert, oriented and reliable patients involved in blunt trauma do not need a routine pelvic roentgenogram if the findings on physical examination are negative.
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The nutritional needs of critically ill septic patients or patients with multiple injuries are often difficult to estimate. Indirect calorimetry can simply and accurately determine individual caloric and nutritional needs, especially in cases of critically ill patients with complicated injuries. This prospective study compared the measured energy expenditures of 30 patients using indirect calorimetry with their predicted basal energy expenditure according to the Harris-Benedict equation, or their calculated energy expenditure derived from basal energy expenditure times, an activity factor, and a stress factor. ⋯ Their stress factors could be modified as "0.97 + 0.0125 x SSS" to get a more accurate Harris-Benedict calculation. For the 15 patients with multiple injuries in whom the measured energy expenditure per kilogram was 34.9 +/- 1.6 kcal/kg, the ISS offered the best correlation with measured energy expenditure per kilogram (r = 0.84, Y = -31.47 +/- 1.73 X). Their stress factors could be modified as "1.04 + 0.0077 x ISS" to get a more accurate Harris-Benedict calculation.