[The anesthesiology department of the new university hospital of Zurich. 1956].
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Biomedical subjects
Publications and source records attributed to P Huguenard.
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A study of patients with serious lower limb injuries is presented. With these injuries it is important to decide whether the limb should be salvaged at the risk of losing a life. Seventy-six patients are described and compared with a group of patients with similar injury severity scores but without serious lower limb injury. It is concluded that it is often preferable to amputate the limb rather than to risk the patient's life. Attempts at preservation of a limb were unsuccessful in 20 of the 54 patients in whom this was attempted. Secondary amputation was often performed in unsatisfactory conditions because of general complications that had resulted from the delay.
This study attempts to objectively estimate the efficiency of early medical care. It is based on the comparison of two series of multiple injured patients. Ten years separated the two groups and during this period, an Emergency Medical Aid Service (SAMU 94) was created. The positive effect of early medical care was established through the variations of injury severity indices currently used in polytrauma: after the institution of Mobile Intensive Care Medical Units on the site of accidents cardiac arrests were ten times less numerous although lesions were more serious in the second series. Without taking into account the mortality rate of lower-limb trauma, where crush syndromes were very numerous, mortality rate decreased as far as spinal, chest, abdominal, and pelvic traumas were concerned. An estimation of the cost of such a system raised the problem of maximizing the efficiency of improved early medical care.
The choice and timing of therapeutic methods for injuries of the lower limbs were evaluated in 60 patients. Primary amputation had to be performed in 18 of them, and conservative treatment was attempted in the others. Sixteen secondary amputations were necessary, mostly for arterial lesions. These results were not in agreement with the general severity of injury, as evaluated by the Injurity Severity Score. There was a significant difference in mortality depending on whether it was decided to amputate secondarily or to preserve the limb. When local signs of complication were present, this difference was highly significant. Age over 50 and arterial lesions were aggravating factors. When present together with an already high severity score, these factors should suggest immediate amputation as a life-saving measure.
Alcoholism is a blight which implicates numerous areas. Polytrauma requires a sometimes long and expensive hospitalization, with a mortality of approximately one in three. In 250 patients (the mean ISS is the same for patients who died, whether nonalcoholics, chronic alcoholics, or occasional drinkers), there was a significant difference between the mortality rate of two-wheeled vehicle drivers and the mortality rate of the light vehicle drivers (p less than 0.05). The risks of morbidity and mortality amongst alcoholics increased for chronic alcoholics (60%) regardless of sex or age differences. Mortality of occasional drinkers was 13.3%, 51% of the offenders were chronic alcoholics. Chronic alcoholism in polytraumatology appears to be a serious element since 59% of multiple injured patients had blood alcohol concentration greater than 1.20 gm/L, 65% greater than 0.80 gm/L, and 70% greater than 0.50 gm/L. Thus chronic alcoholism is a serious index in traumatology.
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From January 1979 to December 1984, 1,272 calls, concerning injured children, aged 11 days to 15 years, justified the intervention of a Mobile Medical Emergency and Intensive Care Service, in the department of "Val-de-Marne" near Paris. Three hundred and twenty-two were very serious trauma children (25%); 45 were in cardiac arrest, and 41 died on the scene of the accident despite the intensive cares delivered by the anesthetists or pediatricians. Two hundred and eighty-one children were hospitalized in an intensive multiple trauma pediatric unit (97 cases) or in a neurosurgical pediatric unit (184 cases). The mode of accident was traffic accident (252), fall (48), fire arms (4), knife wounds (7), hanging or strangulation (9), others (2). They concerned 119 females and 203 males. 126 were multiple trauma children (40%). 37% of these accidents happened between May and July, and 40% occurred between 3 to 6 p.m. The 322 children immediately received medical care but 26% died during their hospitalization (17% in the first 24 hours). Thus mortality rate is 35% (114 cases).
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