Were you knocked out?

In the period 1970-75 inclusive 5152 patients were admitted to an accident hospital after an uncomplicated injury to their head. This group was compared with the 116 patients who needed craniotomy in the same period. It is suggested that precautionary admission of patients with minor head injuries is excessive.

Burn injuries. Initial evaluation and treatment

Treatment of burned patients begins at the scene of the accident, continues in the emergency department, and terminates in the burn center. The "burn team" of specialists includes the paramedic at the scene of the accident, the physician and nurses in the emergency room, and the burn center staff. Since the early stages of treatment often predetermine the final outcome, every physician or nurse who may someday be involved with the initial assessment and management of a severely burned patient should review a plan of evaluation and treatment. Thus, patient salvage from devastating burn injuries will continue to improve.

Genesis of a replantation program

Development of a replantation program entails establishment of microsurgical skills in the laboratory, training in clinical microvascular technics, supervision, if possible, in the first microvascular free flaps, and close liaison with supporting personnel who transport patients, care for them acutely, and carry out their rehabilitation. Of twenty-six replantations or revascularizations (14 incomplete and 12 complete), twenty-three were successful. The three failures (1 complete and 2 incomplete procedures) were all digits, and each was part of a multiple digit injury.

Head injuries in Scottish hospitals. Scottish Head Injury Management Study

A study was designed to discover how patients with a head injury are managed in Scotland. Preliminary findings based on retrospective examination of hospital records describe and compare the characteristics of 3035 patients arriving at accident and emergency departments, 1181 admitted to primary surgical wards, and 424 treated in neurosurgical units in Scotland, excluding the Lothians. These data are being used for further studies to define the needs of these patients and to explore alternative management policies which could make better use of existing health-service resources.

The salvageability of patients with post-traumatic rupture of the descending thoracic aorta in a primary trauma center

If uniform early diagnosis is accomplished, two thirds of patients with rupture of the proximal descending aorta seen at a primary trauma treatment center are potentially salvageable. Currently the survival rate is only one half of this optimum figure (31%). One third of 39 patients with acute rupture of the proximal descending thoracic aorta studied had lethal concomitant injuries and were unsalvageable. Twenty-six patients were potentially salvageable; twelve (46%) survived. Eight potential survivors (31%) died because their aortic rupture was not diagnosed or because it was not promptly diagnosed. Eighteen of the potentially salvageable patients (69%) underwent aortic repair; two thirds survived. Aortic rupture was uniformly diagnosed earlier in the more critically injured patients and thus they underwent aortic repair earlier. One half of the 12 patients in whom thoracotomy was instituted within 6 hours of admission survived; six patients who underwent aortic repair more than 6 hours after admission survived.

Drug dependent individuals dealt with by London casualty departments

During a study of drug incidents dealt with in one month by 62 casualty departments in Greater London, 395 drug-dependent individuals were identified. The great majority of these patients were seen in hospital following an overdose, and barbiturates were the drugs used most frequently. A high incidence of multi-drug use was noted, and many individuals had obtained their drugs from an illicit source. A history of repeated overdosing was common, and one fifth of the patients behaved aggressively while they were in casualty. The implications of these findings are discussed, with particular reference to the demands that are made on casualty departments by drug-dependent individuals.

The Illinois Trauma System: changes in patient survival patterns following vehicular injuries

To assess the impact of the Illinois Trauma Program on Region 5, Southern Illinois, samples of vehicular injuries and deaths were compared for a four-year study period: two years prior to system implementation (FY 1970-1971) and two years after system initiation (FY 1972-1973). Trauma center hospitals exhibited a statistically significant decrease in mortality rate during FY 1972-9173 while other hospitals (those in the region not designated as trauma centers) had no change in mortality rate. Decreases in mortality rates were statistically significant at trauma hospitals for weekends and patients between the ages of 45 and 64. The methodology of conducting such a study as well as the implications of the study are discussed.

[Principles of treatment of patients with multiple injuries]

Treatment of the seriously multi-traumatised patient in accordance with the principles in use at the Unfallkrankenhaus at Linz is illustrated. The different moments of the diagnostic and therapeutic measures, the main aim of which must be the re-establishment of the vital functions (respiration and circulation), are indicated. The article gives diagrams of the classes of priority of the urgent measures to be undertaken in the multi-traumatised patient, drawing attention to all the devices of modern resuscitation. In conclusion there are some observations on organisation of collection of serious multi-traumatised cases.