摘要:

Nine patients on intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP) were allowed to breathe spontaneously at varying end expiratory pressure-end inspiratory pressure (EEP-EIP) gradients up to 10 cm H2O. There was no change in the mean cardiac output and oxygen delivery despite a lowered mean airway pressure (MAWP) when the gradient was increased. Three patients were uncomfortable at the higher gradients and another manifested evidence of fatigue of the muscles of respiration by raising her arterial PCO2(PaCO2) and intrapulmonary shunt (Qs/Qt). In view of the difficulty experienced by some patients and lack of improvement in cardiac outputs (CO) during spontaneous inspiration when the EEP-EIP gradient is raised from zero to 5 and 10 cm H2O, it is recommended that the variation in airway pressure during spontaneous breaths while a patient is on CPAP be minimized.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Missile emboli remain unusual and challenging problems. Failure to recognize and adequately manage these uncommon lesions can result in loss of limb and/or life. No one individual or medical center has an extensive experience with missile emboli. An analysis of approximately 7,500 Vietnam casualties with known vascular trauma revealed an incidence of about 0.3%: 22 patients with missile emboli. The majority were associated with fragments from explosive devices and involved the arterial system. The missile emboli were removed in all but three patients. Only one patient had a vascular complication. There was no mortality or amputation in this series.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

To investigate alterations in host defense produced by trauma, skin testing with five standard recall antigens was done on admission and weekly on 53 patients with blunt trauma and seven with penetrating missile injuries, who then were classified as normal (N), 2 or more positive responses; relatively anergic (RA), one positive response; or anergic (A), no response. Neutrophil chemotaxis was tested 145 times in 32 patients. Degree of injury was assessed by assigning one point to pelvic fracture, long-bone fracture, head, chest, or abdominal injury, to a maximum of five.The A and RA patients had greater trauma, 3 vs. 1.6 for N, and a significantly increased rate of sepsis (p< 0.005) and mortality (p< 0.05). Incidence of anergy depended upon age and extent of trauma. Neutrophil chemotaxis in A and RA patients was significantly (p< 0.001) worse at 96.7 ± 2.4μ and 99.8 ± 1.7μ compared to N, 113.2 ± 1.7μ, and controls, 121 ± 4μ. With recovery, chemotaxis returned to normal. It is concluded that failure of delayed hypersensitivity responses follows trauma, is related to the severity of injury and age of patient, and is associated with an abnormality of neutrophil chemotaxis and increased rate of sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

A porcine burn model demonstrates hypoglycemia in spite of hyperglucagonemia. The ketone response to free fatty acids is defined for the normal and burned pig. Ketogenesis is augmented beyond that expected from free fatty acids during the postburn period. These metabolic changes may be related to the hyperglucagonemia and/or the relative hypoinsulinemia observed in the burned pig.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

PEEP (positive end-expiratory pressure) was required in 12 head-injured patients in whom intracranial pressure (ICP) monitoring had been previously established. In six, ICP increased by 10 mm Hg or more as 4–8 cm H2O of PEEP were administered. In 10 patients the mean arterial pressure decreased during PEEP. Before PEEP, the mean cerebral perfusion pressure (CPP = BP-ICP) was above 50 mm Hg in all patients. The CPP was less than 50 mm Hg in six patients given PEEP. Neurological deterioration occurred in two patients during PEEP therapy. In head-injured patients, optimal titration of PEEP therapy should include ICP measurement and/or continuous evaluation of neurologic status.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Behavioral contracting is a valuable tool for resolving persistent behavioral problems interfering with the treatment and recovery of severely burned patients. Coercive bidding of the patients for more control occurs in an environment where they experience extreme forms of loss of control and associated enforced regression. The ensuing conflicts between patient and staff often lead to breakdowns in mutual cooperation, with deleterious effects on patient-staff morale. Staff experience highly ambivalent feelings toward a problem patient and may wish to withdraw from him, feeling threatened in their image of themselves as competent professionals. Beyond reducing disruptive conflicts on the ward, behavioral contracting aims to mobilize patient and staff around common and explicit goals, and to maximize patient cooperation and productive control in the recovery process.Contracts are valuable because: 1) they facilitate productive communication about issues which underlie patient-staff conflict; 2) they facilitate solutions to problem interactions between patients and staff; 3) they afford both patients and staff a sense of self-control.We provide a rationale for behavioral contracting and discuss the indications for initiating contracts with hospitalized burn patients, and describe methods for developing, implementing, and managing behavioral contracts in order to improve communication and effectiveness in patient-staff interactions.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Autotransfusion of blood from the peritoneal cavity of pigs under a regimen of acid citrate dextrose solution 1:10 v/v for reservoir anticoagulation or systemic heparinization with 300 Iu/kg did not affect cardiac performance. Rapid deterioration of left ventricular pump performance was observed when low dose systemic heparin 100 Iu/kg was used. Evidence suggests that this is related to diffuse coagulation.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The burn eschar is the major source of infection in the severely burned patient, and it hampers healing and prevents skin grafting. Tangential excision has been shown to be safe for rapid removal of the eschar. For the last 14 months we have used this method beginning about 7 days postinjury. Our burn unit is composed of a four-bed, horizontal, laminar airflow isolation system, and transfer out of the sterile environment to the operating room would expose the patient to airborne contamination. Intramuscular ketamine anesthesia was used to allow major debridement to be carried out in the unit itself. Forty-five patients aged 18 months to 71 years have undergone 150 excisions in the burn unit under anesthesia with no complications. The burns ranged from 20 to 75% of body surface (mean, 40%). Because ketamine is a cardiorespiratory stimulant, ventilation and vital signs were well maintained. Psychological side effects of ketamine were minimal, particularly in the younger age group.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The longterm results of surgical and conservative treatment in two almost identical groups of patients with fractures of the ankle have been analyzed. The results were better after conservative treatment; delayed operation and repeated manipulations were found to be the main reason for the poorer postoperative results, especially in elderly osteoporotic patients. The damage consequent to repeated manipulations, the difficulties resulting from delaying operation, and the advantages of early open reduction are discussed. It may be that under certain conditions of unavoidable delay, a mild residual displacement should be accepted rather than repeated manipulation and delayed open reduction. It is concluded that, when indicated, operations should be performed as early as possible after injury, probably giving the best end results as evidenced by the preliminary findings of a prospective study currently under way.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID