摘要:

Hypothermia in trauma patients is generally considered an ominous sign, although the actual temperature at which hypothermia affects survival is ill defined. In this study, the impact of body core hypothermia on outcome in 71 adult trauma patients with Injury Severity Scores (ISS) ≥25 was analyzed. Forty-two per cent of the patients had a core temperature (Tc) below 34°C, 23% below 33°C, and 13% below 32°C. The mortality of hypothermia patients was consistently greater than those who remained warm, regardless of index core temperature. Mortality if Tc < 34°C = 40%, < 33°C = 69%, < 32°C = 100%, whereas mortality if Tc ≥ 34°C = 7%, ≥ 33°C = 7%, and ≥ 32°C = 10%. Mortality and the incidence of hypothermia increased with higher ISS, massive fluid resuscitation, and the presence of shock. Within each subgroup (i.e., greater ISS, massive fluid administration, shock) the mortality of hypothermic patients was significantly higher than those who remained warm. No patient whose core temperature fell below 32°C survived.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Regional blood flow was measured simultaneously in rat sciatic nerves (NBF), truncal skin (SBF), and biceps femoris muscles (MBF) after graded hemorrhages. A modified14C-butanol “indicator-fractionation” technique was used. In controls NBF was 11.4 ± 1.38 ml.min−1.100 gm−1and did not differ significantly between limbs. After hypotension, NBF was: 101 mm Hg, 7.7 ± 1.3; 83 mm Hg, 5.3 ± 0.6; 62 mm Hg, 4.1 ± 0.6; 38 mm Hg, 3.1 ± 0.3. The relationship between NBF and MAP was linear: (r= 0.56;p< 0.001). SBF also declined linearly in hypotension (r= 0.54;p< 0.01), but MBF did not change significantly. No significant change in nerve vascular resistance occurred with hypotension but muscle vascular resistance declined progressively. The data indicate a striking absence of autoregulation of NBF, but MBF, as expected, displayed close autoregulation. The vascular mechanisms which regulate resting NBF following hemorrhage differ from those in both muscle and skin: during hypotension, the calculated neurovascular resistance was unchanged, while the resistance in muscle fell and that in the skin increased.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

It is known that alterations in insulin metabolism following injury and infection result in depression of insulin levels and the development of insulin resistance. In order to further study insulin during septic and traumatic stress, we estimated insulin production in control (Group 1,n= 6), postoperative (Group 2,n= 5), and postoperative-septic (Group 3,n= 8) human subjects by measuring the 24-hour urinary C-peptide excretion. In addition, basal and peak glucose and insulin levels in response to a standard (0.5 gm/kg) intravenous glucose stimulus were measured immediately thereafter to determine if insulin levels reflected insulin production. Basal insulin for Groups 1, 2, and 3 (16 ± 8.4, 10 ± 3.4, 9.5 ± 4.4 μU/ml ± SD, respectively) were not substantially different. Peak insulin response to glucose infusion declined from Groups 1 to 3 (51 ± 14, 42.4 ± 31, 20.4 ± 6.8 μU/ml, respectively) with Group 3 exhibiting a significantly decreased mean peak level compared to the other groups. Corresponding C-peptide excretion rates increased from Groups 1 to 3 (28.3 ± 15.3, 63.7 ± 27.6, 121.3 ± 95.2 μg/day, respectively) with Group 3 exhibiting a significantly (p< 0.05) higher level than Group 1. These data suggest that low insulin levels which may be evident in injured or septic patients not in shock reflect increased clearance and not decreased production. We postulate that increased insulin turnover under these circumstances may contribute to the insulin resistance of post-traumatic or septic stress.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Abnormal profiles of polyunsaturated fatty acids in the plasma phospholipid fraction were observed in 14 patients with hyper metabolism due to severe isolated closed head injury. Depressed linoleic acid levels were observed within 24 hours along with elevation of oleic acid levels. By one week postinjury, subnormal levels of arachidonic acid were also observed. These data indicate that the metabolic response to injury encompasses changes in the metabolism of polyunsaturated fatty acids which are rapid in onset and qualitatively similar to those seen in mild essential fatty acid deficiency.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Logging is among the most hazardous forms of employment. However, a comprehensive review of severe logging injuries and their outcome has apparently not been previously undertaken. In the present study we review 51 consecutive injured loggers requiring transfer to a regional Level I trauma center. The average age was 34 years and the mode of injury in 67% was being struck by a falling or rolling log. Orthopedic intervention was required most frequently (49%), with neurologic injury in 43%. Two patients died (4%), both secondary to severe head injury, and both survived less than 24 hours. Importantly, while most severely injured patients survived, they required long hospitalizations and had a 58% permanent disability, with more than half of these being brain or spinal cord related. Although the overall number of workers involved in logging is small, the young average age, the work years lost, and the high risk of permanent disability support continued strong efforts to improve overall safety. Particularly, the high incidence of head injury argues strongly for improved and increased use of safety helmets, which may significantly impact the mortality and morbidity of logging accidents.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

With increasing frequency trauma surgeons are advocating early internal fixation in open fractures. The effect of the fixation devices on the infection rate in contaminated wounds remains a concern as our clinical experience in this area has been mixed.To study the effects of internal fixation on bone infections a 3.5-mm stainless steel screw was inserted into rabbit femurs and the wounds contaminated withStaphylococcus aureus.The controls had the screw hole drilled and taped but the screw was not inserted. Thirty of 49 rabbits receiving the screw subsequently became infected whereas 19 of 56 control animals developed an infection. The difference was significant at the 0.05 confidence level.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The identification of unstable cervical spine injury (UCSI) in blunt high-energy transfer injury (BHETI) patients is critical to management. In a prospective study of BHETI patients identified to be at high risk for UCSI, the use of lateral cervical spine view (LCV), three-view cervical spine series (FCS), and limited computerized tomography (CT) in the initial evaluation of these patients was analyzed. Thirteen of 204 patients sustained UCSI. Sensitivity of the LCV alone was 0.85 and the predictive value of the negative test was 0.97. Sensitivity and predictive value of a negative study were maximized by the use of FCS combined with CT when plain X-rays were inadequate. We conclude that technically adequate, normal FCS can be safely used to eliminate the presence of UCSI. If these studies are technically inadequate, the addition of a limited CT can be used to “clear” the spine.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study tested the hypothesis that rapidly expanded random pattern skin flaps demonstrate enhanced resistance to bacterial invasion from intradermal injection ofStaphylococcus aureusin a porcine model. Sites for a 6 X 12 cm expanded, a 6 x 9 cm sham-expanded, and a 6 X 6 cm acute random pattern skin flap were outlined, but not elevated, on the backs of 14 white pigs. A 450-cc tissue expander inserted beneath the panniculus carnosus at the site for expansion was sequentially filled to the limits of skin viability each day for 5 days. At the sham site a tissue expander was similarly inserted but left unexpanded; the acute flap site was left undisturbed. On day 8, flaps were elevated, immediately sutured in place, and 0.1 ml of saline solution containing 107Staphylococcus aureusinoculated intradermally at four corresponding sites in each flap and at three sites in normal skin. In seven animals these sites were at the proximal base of the flaps; in seven others the sites were distal. The resulting areas of erythema and skin ulceration were measured on each of the next 3 days and the measurements compared.At corresponding proximal sites, the mean area of erythema and ulceration measured over the next 3 days in expanded flaps (31.2 mm2) and in sham-expanded flaps (33.8 mm2) was significantly less than in acute flaps and control skin (47.5 mm2, 43.4 mm2,p< 0.05). Measurements in the rapidly expanded flaps were not significantly different than those in the sham-expanded flaps. The mean areas of erythema and ulceration at corresponding distal sites were not significantly different.We conclude that both expanded and sham-expanded delayed random pattern flaps demonstrate increased resistance to bacterial invasion compared to normal skin and acute random pattern flaps.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

One hundred patients who were in extremis and required Emergency Room Thoracotomy (ERT) after sustaining penetrating thoracic injuries were analyzed to compare the results of attempted stabilization in the field (n= 51) with those who had immediate transportation (n= 49). The clinical status of the patients in the field and in the E.R. was quantified by Trauma Score (TS) as well as Physiologic Index (PI), ranging in severity from 20 (clinically dead) to 5 (stable). The anatomic injury severity was expressed by Penetrating Trauma Index (PTI). Survival was analyzed according to the type of injuries: noncardiac and cardiac.The overall survival was 10%. There was only one survivor with noncardiac injuries. Sixty-nine patients had cardiac penetration, 33 in Group I (stabilization) and 36 in Group II (immediate transport). Despite attempts at stabilization, none of the patients in Group I showed an improvement in clinical status from the scene to the emergency room. There were a higher number of patients arriving at the E.R. with signs of life in Group II compared to Group I. In Group II patients, survival was significantly improved overall (p= 0.01), in patients with signs of life on arrival at the hospital (p= 0.02) and in patients with isolated right ventricular wounds (p= 0.01) compared with Group I. The anatomic injury severity (PTI) as well as the mode of injury in the two groups was similar.Our data indicate that there is a significant incidence of cardiac trauma in patients in extremis with penetrating thoracic injuries. In the urban setting when the trauma center is minutes away, immediate transportation without attempted stabilization in the field constitutes the optimal prehospital management for these moribund patients.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Exogenous steroid administration has been shown to increase post-traumatic nitrogen excretion in adults. Children sustaining head injuries and treated with steroids have previously been shown to have markedly increased total urinary nitrogen levels; the amount of nitrogen excreted is also directly related to the degree of injury, as evidenced by the Modified Injury Severity Score (MISS). It is unclear whether the increased protein breakdown in these patients is a result of the head injury or a result of the catabolic effects of steroids. Nineteen children aged 4–14 years, suffering head injuries, were prospectively studied. In ten children, management included steroid administration (1–1.5 mg/kg/day dexamethasone X 3–5 days); the remaining nine were similarly managed; however, without steroids. The groups were matched for age, weight, MISS, and Glasgow Coma Scale Score. The steroid-treated group showed a significantly higher urinary nitrogen excretion (mean, 256 ± 24 mg/kg/day) than the nonsteroid-treated group (mean, 172 ± 29 mg/kg/day) (p< 0.02). These data suggest that steroids potentiate an already accelerated post-traumatic catabolic response seen in children with head injuries. Our data suggest that steroid use, which is common, mandates aggressive nutritional support in the management of children with head injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID