ABSTRACT
The emphasis of training for paramedics that function in the civilian sector in the United States has focused on the management of blunt trauma. The personal risks they face generally are the result of accidents or public health threats. The management of penetrating trauma under the threat of intentional personal harm is a different matter.Law enforcement agencies have responded to the threat of apprehending heavily armed felons by forming special units highly trained in military-style, small-unit tactics. To provide care in this special environment, and support a special weapons and tactics (SWAT) team in fulfilling its mission, there is a requirment for a unique body of knowledge and special skills. (Prehospital care providers with at least emergency medical technician [EMT] skills and SWAT training will be referred to as tactical medics.).
Subject(s)
Emergency Medical Technicians/education , Life Support Care/methods , Traumatology/education , Clinical Protocols/standards , Curriculum , Humans , Societies, Medical/organization & administration , Transportation of Patients/methods , Transportation of Patients/standards , Traumatology/methods , Traumatology/standardsABSTRACT
We report a survivor of blunt trauma with rupture of the left ventricle and the interventricular septum. A review of the literature revealed no previous report of a survivor of this combination of nonpenetrating injuries, and only four previous survivors of left ventricular rupture due to blunt trauma.
Subject(s)
Heart Injuries/surgery , Wounds, Nonpenetrating/surgery , Adult , Heart Injuries/physiopathology , Heart Septum/injuries , Heart Ventricles/injuries , Humans , Male , Postoperative Complications , Rupture , Wounds, Nonpenetrating/physiopathologyABSTRACT
This is the first reported case of a meningioma occurring in an achondroplastic dwarf. The patient had been treated for lumbar stenosis 7 years previously and later developed mental status change and visual loss due to a large tuberculum sella meningioma. Statistical analysis of the prevalence of both diseases in the United States shows insufficient evidence for a pathogenetic link between the two diseases.
Subject(s)
Achondroplasia/complications , Brain Neoplasms/complications , Meningeal Neoplasms/complications , Meningioma/complications , Brain Neoplasms/surgery , Female , Humans , Meningeal Neoplasms/surgery , Meningioma/surgery , Middle AgedABSTRACT
A review of the records of 288 patients sustaining blunt cervical column and/or cord injuries revealed that twelve (4.2%) had significant intra-abdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP less than 100 mm Hg) with neurologic deficits were found to have intra-abdominal injuries. Shock in another 15 was the result of major associated injuries and/or the loss of sympathetic vascular tone. Thus 40 of these 58 patients (69%) had neurogenic shock. An analysis of the mechanisms of injury and associated injuries indicated that those at risk of having significant intra-abdominal injury are those who have been injured in a vehicular crash and those who have other obvious major injuries that can cause shock. The data indicate that patients not at risk of having intra-abdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.
