ECKER E T AL

The number and severity of associated injuries obviously is the major factor determining the outcome before the patient reaches the hospital. Injuries to the aorta, heart:, innominate artery, and carotid artery occur frequently in penetrating trauma and result in exsanguina- tion at the scene. In blunt trauma, i n addition to numerous vascular and cardiac injuries the patient may die of injuries of the spine, skull, liver, spleen, or kidney. Those patients who arrive alive are the minor- ity who have escaped these serious injuries.

REFERENCES

1. Aronstam, E. M., Inman, J. G., and Mi,tchell, F. Ruptures in the bronchial tree due to blunt trauma. J. Thorac. Cardiovasc. Surg. 38:93, 1959.

2. Battersby, J. S., and Kilman, J. W. Traumatic injuries of the tracheobron- chial tree. Arch. Surg. (Chicago) 88:644., 1964.

3. Beall, A. C., Jr., Bricker, D. L., Crawford, H. W., and De Bakey, M. E. Sur- gical management of penetrating thoracic trauma. Dis. Chest 49:568, 1966.

4. Beall, A. C., Jr., Ncmn, G. P., and Harris, H. H. Surgical management of tracheal trauma. J . 'Zhuma 7:248, 1965'.

5. Carter, R., Wareham, E. E., and Brewer, L. A. Rupture of the bronchus following closed chest trauma. Amer. J . Surg. 104:177, 1962.

6. Dallas, W. M., Jr. Ruptureseparation of the cervical trachea as a result of blunt trauma. Amer. Surg. 29:529, 1963.

7. Griffith, J. L. Fracmre of the bronchus. Thorax 4:105, 1949. 8. Hood, R. M., and Sloan, H. E. Injuriies of the trachea and major bronchi.

J . Thorac. Surg. 38:458, 1959. 9. Kemmerer, W. T. Patterns of thoracic injuries in fatal trafIic accidents.

J . Trauma 1:595, 1961. 10. Keshishian, J. M., Adkins, P. C., Roll, 'W. E., and Cox, P. A. Surgical man-

agement of penetrating injuries to the diest. Amer. Surg. 31:814, 1965. 11. Mazzei, E. A., and ldulder, D. G. Closed-chest injuries to the trachea and

bronchus. Arch. Surg. (Chicago) 100:677, 1970. 12. Munnell, E. R. Fracture of the major airways. Amer. J . Surg. 105:511, 1963. 13. Paulson, D. L. Traumatic bronchial rupture with plastic repair. J . Thorac.

Surg. 22:636, 1951. 14. Schramel, R., Kelluin, H., and Creech, 0. Analysis of factors affecting sur-

vival after chest injuries. J . Trauma 1:600, 1961. 15. Shaw, R. R., Paulscm, D. L., and Kee, J. L. Traumatic tracheal rupture.

J . Thorac. Cardiovarc. Surg. 42:281, 1961. 16. Soothill, E. F. Closed traumatic rupc.ure of the cervical trachea. Thorax

15:89, 1960.

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298 THE ANNALS OF :rxioucIc SURGERY