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Manual Of Definitive Surgical Trauma Care

Manual Of Definitive Surgical Trauma Care

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Published by bovine splendor
More medical text info for those who cannot access conventional resources.
More medical text info for those who cannot access conventional resources.

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Published by: bovine splendor on Jul 10, 2013
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07/13/2013

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Myocardial contusion has been better defined and a
practice guideline has been developed. Aortic disrup-
tion has become controversial from a diagnostic stand-
point with the introduction of CT and transoesophageal
echocardiography. At this time it is probably best to
consider an arteriogram still as the gold standard. Aortic
disruption is further complicated by the best method-
ology to avoid paraplegia. It is most probable that it can-
not be avoided entirely because it probably represents
an anatomical anomaly in about 5–8 per cent of the
population and there is currently no way to predict this
5–8 per cent and optimally prevent it. Splenic injuries
remain controversial but have been further defined. It
is now clear that anatomical injury severity scales do not

correlate with physiological states and it is not possible
to predict, from the injury severity scales, which organs
can be salvaged and which cannot. It is also appreciated
that splenectomy in the adult does not have the risk
originally assumed. Multiple papers have described the
management of civilian colon injuries and, although
there seems to be some unanimity of opinion that not
all patients require a colostomy, it has not been defined
by practice guidelines precisely which patients benefit
from a colostomy.

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