摘要:

In a 12-year period (1970–1981), there were 112 patients operated on with major open intra-abdominal vascular trauma (MOIVT). These were any penetrating injuries to the aorta, inferior vena cava, portal vein, or their primary branches. Sixty-four patients were treated without benefit of paramedics. Only four of 43 patients who had emergency department blood pressures of 60 mm Hg or greater upon entry died (9.3%), whereas 18 of 21 (85.7%) patients with blood pressures of less than 60 mm Hg die (pForty-eight of the 112 patients have been treated by paramedics during the past 4 years. Entry level blood pressures are those first recorded by the paramedics in the field. The mortality in those with blood pressures of 60 mm Hg or greater remained essentially unchanged. However, 11 of 22 patients with blood pressures of less than 60 mm Hg survived compared to three of 21 (pOver the past 12 years, the community's homicide rate has been stable (71/yr), but the case incidence of MOIVT has risen from an average of 8/yr to 12/yr during the paramedic years. The average annual aggravated assault rate increased from 796 to 1,119. It is believed the improvement in the salvage rate is due to early intervention by trained paramedics functioning within a trauma care system.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Since 1975, more than one thousand children with life-threatening injuries have been preferentially transported to our statewide Regional Pediatric Trauma Center by helicopter or city ambulance. Initial care is provided by emergency medical technicians with special instruction in the handling of pediatric trauma. More than half the children admitted to our service were injured in motor vehicle/pedestrian or motor vehicle/bicycle accidents. Have care and outcome improved? This system provides for excellent first aid at the scene and more rapid radio-directed transport to the trauma center where in hospital management is provided by pediatric and surgical personnel experienced in the treatment of all aspects of childhood trauma. We have organized weekly trauma morbidity and mortality rounds and have established a trauma registry and index of severity. Pelvic fractures from blunt trauma had a mortality in this series of 1.4%, the lowest of any reported experience. Between January 1976 and December 1979, 46 children with coma of longer than 24 hours' duration were treated in the Pediatric Intensive Care Unit. The mortality rate was still high (38%) but employing intracranial monitoring and aggressive control of brain edema, 88% of the survivors had a good recovery without major motor or intellectual defects. The large volume of cases allows for development and evaluation of new techniques in trauma management and invaluable experience in the training of general surgical residents, pediatricians, and emergency physicians.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The implementation of a contemporary comprehensive Emergency Medical Services System (EMSS) has resulted in a change in the method and character of initial response to and overall management of disaster situations. The focus of patient assessment and care responsibilities has shifted from the hospital to the scene of the disaster where triage, evaluation, and medical management of multiple casualties occur. New developments in the organization of EMS Systems dictate that new approaches to disaster planning and preparedness are essential in order to implement the current concepts of emergency medical services. The Boston Emergency Medical Services System has instituted a modern disaster plan which includes principles of hospital categorization, specialty center designation, hospital point-of-entry plans, multihospital resource determination (bed availability), scene triage, patient staging, patient transfer procedures, air evacuation, use of sophisticated telecommunications systems, and regionalization of resources. The activities are all centrally coordinated through one Resource Trauma Center, utilizing a centralized communications center with central medical emergency direction (CMED) capabilities.Four disasters are reviewed: a courthouse bombing with 20 victims, to which there was a 2.5 minute response time, and for which four hospitals were utilized; a factory explosion with 13 critically burned victims air and ground transported to four definitive regional specialty centers; two simultaneous hotel fires with 73 victims who required transport to six hospitals after being treated in on-scene triage areas; and the crash of a jetliner carrying 208 people, 33 of whom required transport to seven hospitals.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The changing economy and greater public awareness of medical costs has created a need to assess efficacy, quality of care, and cost of prehospital treatment by paramedics. The purpose of the present study was to design a simple method for analysis of EMS function using a small number of variables to clearly identify parts of the system needing improvement. The method was used to evaluate EMS in a moderate-sized city over a 1-year period.The log books of paramedic activities and ambulance time records were reviewed and a microcomputer used to abstract the following information felt to comprise the minimum number of variables necessary to assess the system: 1) origin of call; 2) time of call; 3) case type; 4) response time; 5) time spent on scene; 6) transit time to hospital; 7) use of advanced life support (ALS) skills; 8) evaluation of overall run (Category A = Paramedics clearly needed; Category B = Paramedics probably of benefit; Category C = Paramedics clearly not needed, EMT perhaps of benefit; Category D = EMT not needed, first-aid treatment only required).In 1981, the Mobile paramedic system was accessed 4, 698 times. The false alarm rate was 80.4%. Of the 919 cases requiring treatment, 27%, 46%, 11%, 13%, 2%, and 1% were for major medical, minor medical, major trauma, minor trauma, major surgical, and minor surgical problems, respectively. Analysis of patients requiring treatment revealed that 25% of cases fell in Category A, 30% in Category B, 36% in Category C, and 8% in Category D. ALS skills were used in 82% of the 919 cases treated. This included two thirds of the Category C and D cases.Thirty per cent of the Category A cases occurred within 5 minutes of a fullystaffed emergency department; however, in 66% of these cases more than 20 minutes and in 15% more than 30 minutes were spent at the scene. Twenty-six per cent of the Category B cases were within 5 minutes of hospital, yet 32.3% of these cases required 20 minutes and 70% required more than 30 minutes in the field.Evaluation of the Mobile EMS System using this simple format has helped formulate the following priorities to improve cost benefit ratio, to: 1) decrease the false alarm rate; 2) improve the efficacy of EMS dispatchers; 3) improve the appropriateness of field use of ALS skills; 4) reevaluate paramedic training curricula.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Elevation in osmolality occurs after both injury and experimental hemorrhage. Similar elevations in glucose and cortisol have been found to correlate with both injury severity and survival. In this study, we have investigated the relationship between the severity of trauma and changes in glucose, osmolality, and cortisol in injured patients. Trauma severity was estimated using the Injury Severity Score, and correlation coefficients were computed for the three measured variables. Elevations in both osmolality and glucose correlated positively with severity of injury, whereas cortisol did not correlate. Although glucose and alcohol contributed to the rise in osmolality, they did not account for the entire increase.The results indicate that measured increases in osmolality and glucose following trauma may be useful in the prospective evaluation of its severity, especially in those patients with occult major injury. The lack of correlation of increased cortisol with injury severity suggests an interaction of multiple hormones resulting in the increase in osmolality and glucose.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We have previously reported on the efficacy of a 20% fluorocarbon emulsion (Fluosol-DA, 20%) as an acellular O2carrier at an FIO2= 1.0. We are concerned, however, about the potential O2toxicity that may result from extended exposure to FIO2= 1.0. The O2content of the fluorocarbon phase is linearly related to both the FIO2and the fluorocarbon concentration (Fct). It should therefore be possible to maintain the same O2content by raising the Fct using a higher fluorocarbon concentration and lowering the FIO2. The purpose of this report is to assess the ability of a 35% fluorocarbon emulsion (Fluosol-DA, 35%) at an FIO2= 0.6 to support hemodynamics and O2transport.Five adult baboons were paralyzed, anesthetized, intubated, and mechanically ventilated at FIO2= 0.6. An isolvemic total exchange transfusion (E.T.). with Fluosol-DA, 35% was performed. Measurements were made at Hct's of 20, 10, 5, and < 2%. All animals survived the exchange. Total arterial O2content fell from 17.4 ± 0.7 to 3.3 ± 0.2. vol% (p< 0.01), and O2delivery decreased from 21.8 ± 2.2 to 5.1 ± 0.7 cc/min-kg (p< 0.01) during the exchange. There was no significant change in MAP, H.R., C.O., or VO2during the exchange transfusion. Fluosol-DA, 35% maintains normal hemodynamics and O2transport despite a marked fall in arterial O2content and total O2delivery. Fluosol-DA, 35% is thus an effective O2carrier at the safe FIO2of 0.6.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effects of indomethacin, a prostaglandin synthesis blocker, were tested in a porcine model of spetic acute respiratory failure (ARF) produced by continuous infusion of livePs. aeruginosa.Control groups received either indomethacin boluses (2 mg/kg) intravenously at 20 and 210 minutes or Ps.aeruginosainfusion (2 x 108CFU/20 kg/min). The treatment group received both continuousPs. aeruginosainfusion and indomethacin. Indomethacin alone transiently but significantly decreased cardiac indices, heart rate, and PaCO2. WithPs. aeruginosainfusion, significant pulmonary hypertension, hypoxemia, increased intrapulmonary shunt fraction, and systemic hypotension occurred. In this porcine model of septic ARF, indomethacin doubled the survival period and improved cardiopulmonary parameters.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The pulmonary capillary endothelial cell (PCEC) performs many hydrolytic and uptake functions directed toward removal or modification of circulating vasoactive substances. The present study utilized enzymatic hydrolysis of exogenous adenosine triphosphate (ATP) to quantitatively assess the integrity of the PCEC in rate lungs subjected to acute alveolar hypoxia and acute endotoxemia. Both of these experimental conditions produce gross, histologic, and electron microscopic changes that are similar to those associated with shock lung. Sixty-eight male Sprague-Dawley rats were used. In one group of animals acute alveolar hypoxia was induced for 2 hours by reducing the inspired oxygen concentration to 7%. The animals were then assayed for PCEC metabolic activity. In the second group of animals, 20 mg/kgE. coliendotoxin was administered intravenously and the animals were assayed for PCEC hydrolytic activity 4 or 24 hours later. In all animals, the heart and lungs were isolated and perfused with a buffer containing ATP. The amount of inorganic phosphorous (Pi) liberated after passage through the lungs was used as a marker for PCEC activity. In the group of animals given endotoxin, lungs of control animals liberated 0.173 ± 0.047 mg/cc/gm tissue Pi. Animals given endotoxin liberated 0.125 ± 0.071 mg/cc/gm tissue Pi at 4 hours (pp

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A total of 50 nonunions of the forearm bones in 42 patients were reviewed. The mean age was 35.6 years, with the majority secondary to motor vehicle accidents. Five of the nine identified infections were due to primary closure of the initial open fracture. The middle third of the forearm was the most common site of the nonunion. The majority (96%) had significant displacement on the original roentgenograms. Open fractures were more apt to develop nonunions. A gap produced a significant therapeutic challenge and we conclude such are best managed with a bone graft. If a compression plate is applied in the presence of comminution, a bone graft is indicated. The overall success rate with 3 months of D.C. electrical stimulation in the absence of a gap or infection was 80.0%. This compares favorably with time-honored bone graft surgery for nonunion.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID