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Management of open neck wounds
Abstracts
161
Fat embolism in the lungs rise in intracerebral pressure is mediated by the sympathetic nervous system. In experimental dogs the permutations of shock and TURNEY S. Z., LABROSE E., PAUL R., MCASLAN the injection of oleic acid were studied together with T. C., DUNN J. and COWLEYR. A. (1973) The sympacontrols. Lung compliance fell initially and continued thetic response in head trauma. Ann. Surg. 177, 86. to fall in those animals which were both shocked and had oleic acid injected. Those animals in which only Management of open neck wounds one of these factors was present began to recover A policy of management is described. Observation after the first day. was all that proved necessary in over 60 per cent of DERKS C. M. and PETERSR. M. (1974) The effect cases. Active bleeding, however, or injury to larynx, of shock and fat embolism on pulmonary mechanics trachea, pharynx or oesophagus required urgent and gas exchange. Surg. Gynecol. Obstet. 138, 413. surgery. Post-traumatic fat embolism DE LA CRUZ A. and CHANDLER J. R. (1973) Management of penetrating wounds of the neck. Surg. Three cases of severe fat embolism after multiple Gynecol. Obstet. 137, 458. injuries are presented in which the disease developed between 6 and 48 hours after the accident. The authors Traumatic spinal paralysis in children stressed the importance of retinal changes in the Study of case records of all children under 13 years diagnosis as well as the classic petechial haemorseen at Ranch0 Los Amigos with traumatic spinal cord rhages. They secured a full recovery in all 3 cases by lesions. Study includes 29 children. Causes were: tracheal intubation and positive-pressure respiration 5 birth injuries; 16 road traffic accidents (10 passenger, maintained for several days, by the use of high doses 6 pedestrian); 7 falls from height; 1 struck by steel of hydrocortisone, a fat-emulsifying agent called bar. Of the birth injuries 4 were delivered by breech Lipostabyl and the protein inhibitor Trasylol. The presentation. patients were able to return home in good condition Of the 29 lesions, 25 were complete and 4 incomat 1 month, 60 days and 80 days respectively. plete. Eighty per cent of the major spinal cord BELLOTTI C., FORMAGGIO G., GATTI G. and injuries showed no or minimal X-ray evidence of REGALIAF. (1975). Three cases of post-traumatic fat vertebral injury. embolism. Minerva Ortopedicu 26, 331 (Italian). Primary treatment included laminectomy in 13 Organization topics and accident patients;21 patients had oneor more fusion operations prevention for kyphoscoliosis. No evidence that benefit had arisen from laminectomy. Consensus favoured conMovement of critically ill patients within servative management of deformities. hospital Valuable suggestion supported by some pathologiMoving patients about a hospital after they had been cal evidence that major cord lesion without evidence operated on was less likely to lead to complications of bony injury might arise from traction on the cord. than moving critically ill patients, of whom one a BURKED. C. (1974) Paraplegia 2, 268. month suffered ‘major cardiorespiratory collapse or death’. Bleeding into the chest seemed to carry a Pathogenesis of myelopathy in cervical particular risk of complication. Moving patients by spondylosis ambulance is apparently less hazardous than moving The neurological signs of myelopathy are often at them on trolleys or their beds in hospital and this different levels from the radiologically manifest may be because greater care is taken in preparation changes of spondylosis, there may be no demonfor a journey by ambulance. strable compression of the cord by osteophytes or WADDELLG. (1975) Br. Med. .I. 2,417. other protusions, and the blood vessels may be free Accident and emergency services in Russia from demonstrable disease. Experimental work supports the hypothesis that the blood supply to the The authors visited several centres but describe spinal cord can be reduced by spasm induced by particular conditions in Kiev, where a population of irritation of the sheaths of posterior roots resulting 2f million are served by more than three times as many from fibrosis associated with degenerative changes doctors as would be available in Britain and by 125 in the intervertebral and zygapophyseal joints. ambulances by day and 86 at night. Telephone calls GOODING M. R. (1974) Lancet 2, 1180. to a central office are dealt with by nurses in many cases and by doctors if necessary. Ambulances carry Fat embolism specially trained and equipped doctors and nurses Fat embolism in combat casualties with specialist teams and equipment available for gynaecological, toxic, psychiatric and other conA description of 15 cases, including a useful analysis ditions. Admissions are arranged by ambulance of symptoms and signs and also an evaluation of crews or the polyclinics (health centres) that adjoin treatments. All patients were confused or comatose. district hospitals, thereby doing away with the need for About half died. hospital casualty departments. MCNARAMA J. J., MOLOT M., DUNN R. and They were favourably impressed by the organizaSTREMPLEJ. (1972) Clinical fat embolism in combat tion and efficiency of the service, and report that casualties. Ann. Surg. 172, 54.
161
Fat embolism in the lungs rise in intracerebral pressure is mediated by the sympathetic nervous system. In experimental dogs the permutations of shock and TURNEY S. Z., LABROSE E., PAUL R., MCASLAN the injection of oleic acid were studied together with T. C., DUNN J. and COWLEYR. A. (1973) The sympacontrols. Lung compliance fell initially and continued thetic response in head trauma. Ann. Surg. 177, 86. to fall in those animals which were both shocked and had oleic acid injected. Those animals in which only Management of open neck wounds one of these factors was present began to recover A policy of management is described. Observation after the first day. was all that proved necessary in over 60 per cent of DERKS C. M. and PETERSR. M. (1974) The effect cases. Active bleeding, however, or injury to larynx, of shock and fat embolism on pulmonary mechanics trachea, pharynx or oesophagus required urgent and gas exchange. Surg. Gynecol. Obstet. 138, 413. surgery. Post-traumatic fat embolism DE LA CRUZ A. and CHANDLER J. R. (1973) Management of penetrating wounds of the neck. Surg. Three cases of severe fat embolism after multiple Gynecol. Obstet. 137, 458. injuries are presented in which the disease developed between 6 and 48 hours after the accident. The authors Traumatic spinal paralysis in children stressed the importance of retinal changes in the Study of case records of all children under 13 years diagnosis as well as the classic petechial haemorseen at Ranch0 Los Amigos with traumatic spinal cord rhages. They secured a full recovery in all 3 cases by lesions. Study includes 29 children. Causes were: tracheal intubation and positive-pressure respiration 5 birth injuries; 16 road traffic accidents (10 passenger, maintained for several days, by the use of high doses 6 pedestrian); 7 falls from height; 1 struck by steel of hydrocortisone, a fat-emulsifying agent called bar. Of the birth injuries 4 were delivered by breech Lipostabyl and the protein inhibitor Trasylol. The presentation. patients were able to return home in good condition Of the 29 lesions, 25 were complete and 4 incomat 1 month, 60 days and 80 days respectively. plete. Eighty per cent of the major spinal cord BELLOTTI C., FORMAGGIO G., GATTI G. and injuries showed no or minimal X-ray evidence of REGALIAF. (1975). Three cases of post-traumatic fat vertebral injury. embolism. Minerva Ortopedicu 26, 331 (Italian). Primary treatment included laminectomy in 13 Organization topics and accident patients;21 patients had oneor more fusion operations prevention for kyphoscoliosis. No evidence that benefit had arisen from laminectomy. Consensus favoured conMovement of critically ill patients within servative management of deformities. hospital Valuable suggestion supported by some pathologiMoving patients about a hospital after they had been cal evidence that major cord lesion without evidence operated on was less likely to lead to complications of bony injury might arise from traction on the cord. than moving critically ill patients, of whom one a BURKED. C. (1974) Paraplegia 2, 268. month suffered ‘major cardiorespiratory collapse or death’. Bleeding into the chest seemed to carry a Pathogenesis of myelopathy in cervical particular risk of complication. Moving patients by spondylosis ambulance is apparently less hazardous than moving The neurological signs of myelopathy are often at them on trolleys or their beds in hospital and this different levels from the radiologically manifest may be because greater care is taken in preparation changes of spondylosis, there may be no demonfor a journey by ambulance. strable compression of the cord by osteophytes or WADDELLG. (1975) Br. Med. .I. 2,417. other protusions, and the blood vessels may be free Accident and emergency services in Russia from demonstrable disease. Experimental work supports the hypothesis that the blood supply to the The authors visited several centres but describe spinal cord can be reduced by spasm induced by particular conditions in Kiev, where a population of irritation of the sheaths of posterior roots resulting 2f million are served by more than three times as many from fibrosis associated with degenerative changes doctors as would be available in Britain and by 125 in the intervertebral and zygapophyseal joints. ambulances by day and 86 at night. Telephone calls GOODING M. R. (1974) Lancet 2, 1180. to a central office are dealt with by nurses in many cases and by doctors if necessary. Ambulances carry Fat embolism specially trained and equipped doctors and nurses Fat embolism in combat casualties with specialist teams and equipment available for gynaecological, toxic, psychiatric and other conA description of 15 cases, including a useful analysis ditions. Admissions are arranged by ambulance of symptoms and signs and also an evaluation of crews or the polyclinics (health centres) that adjoin treatments. All patients were confused or comatose. district hospitals, thereby doing away with the need for About half died. hospital casualty departments. MCNARAMA J. J., MOLOT M., DUNN R. and They were favourably impressed by the organizaSTREMPLEJ. (1972) Clinical fat embolism in combat tion and efficiency of the service, and report that casualties. Ann. Surg. 172, 54.