Shotgun 'birdshot' wounds to the neck.
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Adult↗
Biomedical subjects
S Balasubramanium
Publications and source records attributed to S Balasubramanium.
Serum digoxin levels and mortality in 5,100 patients.
A retrospective study of 5,100 patients on digoxin, with a four-week follow up after digoxin levels were measured, was done to determine the mortality rate. A significant increase in mortality was correlated with an increasing serum digoxin level, up to 50% at a level of 6.0 ng/mL and more. Clinical toxicity was suspected in only 0.25% of all patients on digoxin, although almost 10% had levels above the therapeutic range. Deliberate digoxin overdoses were fatal in 50% of cases. This study shows a correlation between increasing digoxin levels and increasing mortality rates. We recommend the use of serum digoxin measurements to identify those asymptomatic patients with elevated levels. The physician should seriously consider the indications for initiating or continuing digoxin treatment in any patient because of an increased mortality in patients with levels of more than 1.0 ng/mL.
Adult↗
Electronic gun (Taser) injuries.
The Taser is an electrical weapon used for immobilization. Two hundred eighteen patients who were shot by police with a Taser for violent or criminal behavior were compared to 22 similar patients shot by police with .38 Specials. The long-term morbidity rate was significantly different for "tasered" victims (0%) and for those with bullet wounds (50%) (P less than .05). The mortality rate was also significantly different between "tasered" victims (1.4%), and gunshot wound victims (50%) (P less than .05). Possible complications associated with Taser wounds included contusions, abrasions, and lacerations (38%); mild rhabdomyolysis (1%); and testicular torsion (0.5%). Although 48% of "tasered" patients required hospitalization, all but one was for a preexisting injury or toxic or psychiatric problem. We conclude that Tasers are relatively safe when compared to shooting with more conventional weapons.
Adolescent↗
Coagulation abnormalities in traumatic shock.
Coagulation abnormalities can pose a threat to hemorrhaging patients and to attempts at surgical correction. We have shown that 97.2% of our 180 patients who died of trauma had evidence of coagulation defects prior to fluid or blood treatment. Twelve of 180 patients could not be cross-matched due to inability of their blood to coagulate in the tube. Clinically 50% of these patients had excessive oozing from venipuncture sites, and 28% had excessive hematoma formation not associated with vascular injury. The most frequently abnormal test was the prothrombin time, in 97% of patients followed by platelet count in 72%, and partial thromboplastin time in 70%. The greatest degree of coagulation abnormality occurred in patients with head trauma, followed in decreasing order by gunshot wounds, blunt trauma, and stab wounds to the body. Because 97.2% of the patients had abnormal coagulation studies prior to fluid and blood replacement, this abnormality most likely was due to disseminated intravascular coagulation. We propose using the tube-clot test to give a rapid indication of coagulation in traumatized patients while awaiting laboratory test results.
Adolescent↗
Rat bites: fifty cases.
A prospective study of 50 patients with uninfected rat bite wounds was undertaken to determine the natural incidence of wound infection without prophylactic antibiotics. All open wounds were cultured; bacterial isolates were cultured from 30% of wounds. Of bacterial isolates, 43% were Staphylococcus epidermidis and the remainder were Bacillus subtillus, diphtheroids, and alpha hemolytic Streptococcus. Only one patient (2%) developed an infection. Seventy-two percent of the bites occurred while the patient was sleeping, probably accounting for the fact that 84% of the wounds were on the exposed areas of the upper extremities and face. Treatment recommendations include good surgical management and avoidance of prophylactic antibiotics due to a low natural infection rate. If the wounds become infected, then a cephalosporin or penicillinase-resistant penicillin should be sufficient for treatment with appropriate surgical care of the wounds. Rabies prophylaxis usually is not required, but we suggest that tetanus prophylaxis is mandatory because most of our patients were deficient in this regard.
Adolescent↗
Wound ballistics: theory and practice.
Ballistics is the study of the natural laws governing projectile missiles and their predictable performances, and wound ballistics is the study of a missile's effect on living tissue. A knowledge of these topics is essential to determine the extent and type of injury from a missile. The type of missile can often be determined by radiography. The caliber can be measured directly if the bullet is close to the x-ray plate and the x-ray tube is at least six feet from the film. Changing these distances can result in a maximum magnification of the bullet image of 20%, and the exact amount can be calculated using a formula provided. Definitions of ballistic and wound ballistic terms are provided, as are examples of wound ballistics in application.
Humans↗
Outpatient management of 357 gunshot wounds to the chest.
There is, at present, little literature to guide one in the management of a patient with a gunshot wound to the chest with normal vital signs, physical examination, and as a normal chest X-ray. The present study followed up 357 patients as outpatients at 48 hours, then 1 and 3 months. No major complications developed. Minor complications included chronic wound pain, chronic wound swelling, and the uncomfortable sensation of being able to palpate one's own subcutaneous bullet. The wound infection rate was only 1.5% with or without antibiotics, showing that prophylactic antibiotics are probably not warranted if good surgical wound care is practised. We conclude that patients with gunshot wounds to the chest with normal vital signs, physical examinations, and normal X-rays can be reasonably treated as outpatients after 4 hours of observation, at the physician's discretion.
Adolescent↗