ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Maintenance of a patent and secured airway is essential to the management of trauma, and requires physicians experienced with airway control techniques. Trauma-setting airway control problems can be caused by vital failures, risk of aspiration, potential for cervical spine injury, combative patients, and the obvious risk of difficult tracheal intubation related to the specific injury of the patient. Endotracheal intubation remains the gold standard in airway management for trauma patients, and should be performed via the oral route, with a rapid sequence induction and a manual in-line stabilization maneuver, to circumvent some of the problems previously mentioned. In this paper different techniques to control the airway in trauma patients are discussed, including lighted stylet tracheal intubation, improvement of the laryngoscopic vision, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube, and cricothyroidotomy. Airway management in trauma patients requires regular training in these techniques, and knowledge of complementary techniques that allow tracheal intubation or oxygenation to overcome difficult intubation is vitally important.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Penetrating trauma to the thorax and abdomen commonly produces injuries that are an immediate threat to life. Rapid decision making and treatment of these patients are essential. Treatment decisions must be based on the patient’s hemodynamic status and likely trajectory of the bullet or knife. Patients who are in extremis or are unstable require immediate intervention, minimizing diagnostic procedures that delay essential care (generally thoracotomy or laparotomy). The surgical approach to the victim of penetrating injury to the chest or abdomen will vary significantly depending on the anatomic structures potentially at risk based on the trajectory of the missiles. A fundamental understanding of ballistics is important in the treatment of penetrating thoraco-abdominal injury.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

There is no consensus regarding the optimal treatment of hemorrhagic shock in trauma patients. Continued controversy exists regarding the most appropriate fluid during trauma resuscitation. Published data can be found in support of isotonic crystalloids, hypertonic solutions, colloids, and, recently, blood substitutes. None of these prospective randomized clinical studies were large enough (sufficiently powered statistically) to demonstrate a survival benefit for any particular type of volume resuscitation. Ongoing investigations in fluid resuscitation are changing our understanding of the treatment of shock. This update reviews the recent literature on fluid resuscitation in the trauma patient and speculates on future trends in this exciting field.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Pelvic fractures account for 3% of all fractures seen in the emergency room. Hemorrhage as a result of bony bleeding or a disruption of the surrounding venous and arterial vessels has been implicated as a significant cause death in emergency-room patients with fractures. Pelvic fractures are often associated with injuries to the abdomen, thorax, and head, which further contribute to the outcome of patients with pelvic fractures. Hypotensive patients with these fractures present a major challenge in diagnosis and treatment of the bleeding source; these patients require early and aggressive treatment by a multispecialty team to increase patient survival. The optimal timing and indications for currently available diagnostic and therapeutic approaches remain controversial.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Severe sepsis and related generalized insults induce in the host an immunologic response to injury characterized by an increase in both pro-and antiinflammatory processes. This apparent dysregulation of the inflammatory process is partly due to cellular and subcellular alterations in antigen processing, signal transduction, and cell adhesion molecule expression. Although the proximal processes of inflammation includes release of proinflammatory mediators and increased expression of activated immune effector cells, antiinflammatory mediators and processes are simultaneously initiated but at a slower rate. Intracellular balance centers around the oxidative stress signaling pathways for heat shock factor and nuclear factor-κB (NF-κB), which once activated promotes signal translation for many of the proinflammatory mediators and enzymes. Whereas heat shock factor stimulates increased synthesis of heat shock proteins that minimize subcellular injury and blunt the inflammatory response, the cellular expression of this process is an increased display of activated β2-integrin adhesion molecules (proinflammatory response) and a blunted ability to up-regulate this display in response to further proinflammatory stimuli (antiinflammatory response). Diagnostic studies and therapies that aim to reduce organ injury and improve outcome for critical illness will need to monitor these aspects of the host’s inflammatory response and vital signs, organ function, and other biological markers.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Literature from 1999 on the endotoxin adsorption therapy, PMX, is reviewed. There has been no double-blinded controlled trial. Several papers reported controlled trials. The authors of these studies effectively treated septic patients with peritonitis after operation. Efficacies with PMX were demonstrated much more clearly in the patients with gram-negative sepsis or endotoxemia. The survival rate (14 days or 28 days after PMX) was compared between patients who received conventional treatment, those who received continuous hemofiltration (CHF), and those with disease of similar severity. The factors used to estimate the efficacy of PMX, aside from survival, were improvement in clinical findings and severity of symptoms as well as cardiovascular and mediator changes. Reduction of cytokines and other mediators during 2-hour PMX was also confirmed. Its mechanism of action is the blockade of endotoxin signal transduction due to endotoxin removal. It was reported that the mechanism of elevating blood pressure during PMX was adsorption of endogenous cannabinoid.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Recently, blood purification has come to be considered as a useful modality for the removal of humoral mediators of sepsis and septic multiple organ failure. An endotoxin-adsorbing column and continuous hemofiltration (CHF) or continuous hemodiafiltration (CHDF) are most frequently applied for this purpose. However, as for the endotoxin-adsorbing column, indications seem to be limited, since the number of patients in whom endotoxin plays an important role is relatively small. Furthermore, the endotoxin-adsorbing column itself should be improved to achieve better removing capacity. As for CHF and CHDF, their removal capacity for cytokine is dependent on the membrane material, because adsorption of cytokines to the membrane is an important mechanism of cytokine removal. Clearance of cytokine with CHF or CHDF also depends on the pretreatment blood level of cytokines. Therefore, CHF and CHDF can remove cytokines from circulation when proper membranes with adsorbing capacity are used and when prefiltration blood level of these cytokines is high. There has been no large-scale clinical trial reporting the efficacy of CHF or CHDF as a method for cytokine removal, however. A prospective randomized clinical trial is badly needed before these modalities can be widely used for the treatment of sepsis.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID