Experimental and Theoretical Aspects of Severe Trauma

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It appears that combined radiation injury is more than the simple sum of trauma and radiation injury: it is a new condition to be considered in determining the course, management, and eventual outcome of trauma.Burns compounded by whole-body irradiation result in increased mortality, with the most marked increase in mortality in the first forty-eight hours if strenuous resuscitation is not effected.Clinically, soft-tissue wounds are relatively unaffected by radiation if wound infection is not a problem, that is, in the closed wound. However, secondary closure of an open wound will be a problem. It will either have to be carried out before the response to radiation, as indicated by bone-marrow depression, or deferred until after recovery. Any surgical procedure carried out during the period of response to radiation will only add to the patient's morbidity. Radiation does not appear to alter the effectiveness of antibiotics against sensitive wound organisms.Closed fractures heal uneventfully when complicated by whole-body irradiation. However, with the response to radiation, the fracture callus softens and fragment fixation requires external support. With recovery from radiation, the bone fragments should unite. The problem of the compound fracture is the problem of the soft-tissue wound.Laboratory studies indicate that postirradiation anesthesia may modify immediate survival in either direction. Certainly in the mid-lethal dose ranges the anesthetic problems are secondary to the problems of the wound and of resuscitative effort.Time beneficial effect of penicillin applied topically appears real and consistent, and it seems quite definitely to surpass that of bacitracin-neomycin. The drugs consistently result in prolonged mean survival time. In the case of the wounded soldier, this could mean significant lengthening of the golden period the time between wounding and the need for definitive surgical treatment of the soft-tissue wound before the onset of irreversibility. Thus perhaps the prolonged recovery and evacuation which new military tactics seem to dictate can be countered.

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