摘要:

Eight patients with severe tetanus experienced episodes of marked cardiovascular instability. During these unstable periods, cardiac output and vascular resistance varied independently. Beta blocking and low doses of ganglionic blocking agents failed to control cardiovascular instability even when combined. High doses of ganglionic blockers stabilized hemodynamics for a short period, but caused the elevation of transaminases. After unsuccessful treatment with cardiovascular drugs, continuous spinal anesthesia (CSA) was applied to five patients. For 5 to 23 days circulation was regulated artificially under complete blockade of the autonomic nervous system by infusing isotonic 0.5% bupivacaine intrathecally. Catecholamine was added intravenously to maintain adequate blood pressure. Before the introduction of CSA, three patients died of circulatory failure. In contrast, CSA dramatically suppressed the cardiovascular instabilities, and all five treated patients survived. This suggests that both sympathetic and parasympathetic nervous systems need to be blocked to stabilize hemodynamics in severe tetanus.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effectiveness of closed chest cardiopulmonary resuscitation (CCCPR) in maintaining cardiac output has been well studied in cardiac arrest. Trauma surgeons most often encounter shock secondary to hypovolemia or cardiac tamponade, and the effectiveness of CCCPR in that setting has not been established.To determine the hemodynamic effects of external massage in profound shock, hypotension was induced in baboons. Pressures obtained with external massage were compared to spontaneous intra-arterial pressures before compression. Although external massage increased systolic pressures in both tamponade and hypovolemia, diastolic pressures were consistently decreased.We conclude that CCCPR does not augment arterial pressure in the clinical situations associated with decreased LVEDV and is unlikely to provide organ perfusion for trauma victims.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

During a 6-year period, 14 consecutive children with penetrating craniocerebral gunshot wounds (GSW) were studied. Eleven patients were comatose on admission. Five had an admission Glasgow Coma Scale (GCS) score of 4 or less and developed clinical signs of brain death within 12 hours despite maximum therapeutic efforts. The remaining six patients, all of whom had three or more of the previously described unfavorable prognostic features, were aggressively managed with prophylaxis and treatment of intracranial hypertension. Intracranial pressure (ICP) was controlled with mechanical hyperventilation, mannitol osmotherapy, pentobarbital, and surgical decompression. Substantial intracranial hypertension occurred for up to 10 days after admission. There were four survivors. Neurobehavioral and intellectual functions were evaluated over a period of 1 to 2 years. Although serious cognitive deficits were noted, all survivors had sufficient functional recovery to warrant aggressive cardiopulmonary resuscitation and measures to control ICP in the management of comatose victims of craniocerebral GSW.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Common emergency room practice mandates cervical spine (C-spine) films in all trauma patients with potential injuries. With the increasing costs of medical care, such liberal criteria may not be justified. This 1-year prospective study of 860 patients who presented to a Level I Trauma Center was undertaken to determine the signs and symptoms that would select the patients at risk of C-spine injury. The clinical presentation of each patient was correlated with the presence of C-spine fracture. Twenty-four patients (2.8%) had injuries demonstrated by plain film radiography. The incidence of fracture in 536 symptomatic patients was 4%. A significant likelihood of C-spine fracture was seen in patients with respiratory compromise (100%), motor dysfunction (54.5%), and altered sensorium (8.9%) (p< 0.001). No fractures were seen in asymptomatic patients (p< 0.001). Cervical spine radiography should be performed in patients with abnormal neurologic findings or symptoms referable to the neck. In alert asymptomatic patients, cervical spine radiography may be omitted.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have recently shown that nimodipine, a calcium channel blocker, can increase spinal cord blood flow (SCBF) in normal rats and can improve SCBF after spinal cord trauma if the mean systemic arterial pressure (mSAP) is restored to normal levels by the vasopressor, adrenalin. The present study is a further analysis of the improvement in post-traumatic SCBF (measured with the hydrogen clearance technique) with the combination of adrenalin and nimodipine. In addition, image analysis was used to study the potential risk of this combination for exacerbating intramedullary hemorrhage in the injured spinal cord. SCBF, mSAP, and other physiologic parameters were measured preinjury, postinjury, and post-treatment. A 53.0-gram clip compression injury at the T1 spinal segment was delivered for 1 minute to three treatment groups (saline, adrenalin, and adrenalin plus nimodipine) comprised of five rats each.Injury caused a marked decline in SCBF and mSAP. Treatment with adrenalin alone or combined with nimodipine (1.5 μg/kg/min IV) improved mSAP to 100–125 mm Hg. However, adrenalin alone failed to improve SCBF, whereas nimodipine plus adrenalin produced a marked improvement of approximately 60% in post-traumatic SCBF. Morphometric analysis showed no significant difference between per cent area or volume of hemorrhage between the three treatment groups, although there was a trend for increased hemorrhage in the adrenalin-alone group perhaps due to the higher post-traumatic mSAP in this group. Further studies are required to find the minimal elevation in mSAP produced by a vasopressor that would still cause an improvement in post-traumatic SCBF by nimodipine, and to determine whether this combination improves function after spinal cord injury.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Four patients sustaining tarsal navicular body fractures are presented. Analysis based on these cases and on 36 patients suffering from identical fractures reported in the literature led to a new mechanical assumption: the axial compression on the foot, as a result of falling from height, causes impaction of the talus into the body of the navicular bone.The clinical followup results reported are usually disappointing. Favorable results are obtained in a vertical two-part fracture, by an open reduction and internal fixation of the tarsal navicular body fracture. In highly comminuted fractures, talo-navicular-cuneiform arthrodesis can be carried out.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID