摘要:

The most common bleeding and clotting problems in post-traumatic states are reviewed. The normal response of the coagulation system and the fibrinolytic system to trauma is described; this response must be considered when studying the abnormal situations. The laboratory tests need not be numerous or sophisticated but they must be repeated often enough to understand and interpret the data. A proper understanding of these abnormalities forms the rational basis for the correct choice of therapy, and is of utmost importance in the management of post-traumatic patients.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Initial fluid management of the injured patient involves replacement of fluid lost incident to the trauma as well as prompt recognition and treatment of shock. Prompt fluid replacement based on these concepts will result in a reduction in mortality and prevention of many complications resulting from prolonged inadequate tissue perfusion. In this discussion, an attempt will be made to facilitate this approach by: (1) discussing these fluid changes; (2) presenting a clinically applicable classification of shock; and (3) outlining a rational approach to the early treatment of hemorrhagic shock, the most frequent form of shock occurring early after injury.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Thromboembolic disease ranks among the most dangerous and common complication in the postoperative or post-traumatic patient. As previously mentioned, the incidence is increasing and fatalities from this complication have also risen substantially. The pathogenesis of thromboembolic disease and the predictability of its occurrence remain elusive. Based upon evidence suggesting that the thrombotic process may begin during surgery, greater attention should be given to the use of prophylactic agents before as well as during the operative procedure. The search continues for a safe, oral agent uniformly effective in preventing thromboembolism.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Trauma causes a definite increase in packed cell viscosity and intravascular cellular aggregation. As a result, total body oxygen consumption decreases markedly. When packed cell viscosity is lowered by infusion of dextran-40, total body oxygen consumption progressively increases to normal values. It does not appear unreasonable to conclude that in traumatized patients, restoration of microcirculatory blood flow is of great importance in reestablishing an effective circulating blood volume and that normalization of blood viscosity after trauma may be of considerable benefit.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

There appears to be a great similarity between all of the various types of Adult Respiratory Distress Syndromes (ARDS) in that they are all characterized by progressively increasing interstitial edema in the lungs and a reduced functional residual capacity. Early diagnosis is mandatory and therapy should be started as soon as there is a reasonable suspicion, based on the patient's injury or illness and the previous condition of his lungs, that acute respiratory failure is developing. Sepsis, shock, CNS or thoracic disease and trauma are important associated factors.Blood gas changes usually cannot be appreciated clinically until the respiratory problem is quite severe. Accordingly, serial blood gas analyses should be performed on any patient who has a reasonable chance of developing ARDS. We have found that changes in the estimated AaDo2on room air are especially helpful. Any deterioration in the patient's clinical condition, blood gases or ventilatory effort should be considered as an indication for early ventilatory assistance.Control of the primary process, careful dehydration, high tidal volumes, and PEEP are the mainstays of therapy. Serial blood gases and careful observation of the patient's effective compliance are essential to determine the optimal ventilator settings and the optimal amount of PEEP. Recently intermittent mandatory ventilation (IMV) with very large amounts of PEEP have been reported to be of value. Early administration of massive steroids should be considered if the patient fails to respond promptly to correction of the underlying etiologic problem, particularly sepsis, careful progressive dehydration and optimal expansion of the alveoli, with high tidal volumes and PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The limited variation of pulmonary responses to disease—dyspnea, cough, production of adventitious sounds, sputum production, and hemoptysis—complicates the differential diagnosis of the acutely ill patient with obvious severe pulmonary disease. This paper attempts to reinforce and redefine this problem: acute cardiac and pulmonary dyspnea can generally be separated by quick but careful clinical analysis; misdiagnosis may lead to disaster since effective treatment of one is frequently harmful to the other.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID