摘要:

There is continuing controversy over the use of Advanced Life Support (ALS) in the treatment of multisystem injury. In this study, performed to define the role of ALS in the management of motor vehicle accidents (MVA), 538 ambulance run reports (ARR) and hospital records of patients involved in MVA in South Carolina for 1983 were examined. Of these, 248 were reviewed in depth by a trauma review committee (TRC). Paramedics were present in 81% (93% urban, 80% rural) of cases. ALS crews averaged 24.8 minutes on the scene compared to 18.1 minutes for Basic Life Support (BLS). It took 6 minutes longer to transport rural patients than urban patients (15.7 vs. 9.6 min). Total EMS time (response, on scene, transport) was 46 ± 20 minutes. Extrication increased on-scene time from 20.5 to 31.1 minutes. Endotracheal intubation attempts were 67% successful and IV's were placed in 88% of attempts. Thirty-two per cent of ALS patients demonstrated an increased blood pressure en route compared to 12% of BLS patients. The TRC felt prehospital care was beneficial in 85% of cases, while 11.7% had inappropriate or inadequate care. Resuscitation and ALS in MVA appears to be beneficial in the treatment of multisystem trauma in a rural state.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Septic surgical patients often require fluid administration to maintain cardiovascular stability due, in part, to the sepsis-induced increase in vascular permeability and associated plasma volume depletion. Plasma fibronectin deficiency exists in such septic patients. We determined if maintenance of fibronectin levels by administration of fibronectin-rich human plasma cryoprecipitate would lower the resuscitative fluid volume needed for support of arterial pressure in septic postoperative sheep which were experimentally depleted of plasma fibronectin. Following a 2-hr postoperative baseline period, denatured collagen (gelatin, 8.7 mg/kg), which has a high affinity for fibronectin, was infused into both control and experimental sheep in order to acutely deplete plasma fibronectin. Sheep were then challenged both intraperitoneally and intravenously with live Pseudomonas (5 x 1010bacteria IP; 5 x 109bacteria IV). Experimentals were given fresh plasma cryoprecipitate intravenously at a dose of 4 units bolus, followed by 3 units/hr for 5 hr. Controls received plasma cryoprecipitate selectively depleted of fibronectin by affinity chromatography. Bacterial challenge rapidly resulted in severe systemic hypotension. Ringer's lactate was infused intravenously into both groups at a rate sufficient to maintain a systemic arterial pressure of approximately 50 mm Hg with a maximum pulmonary artery wedge pressure of 15—18 mm Hg. Its rate of infusion was periodically adjusted to maintain this hemodynamic status. Comparison was made of the volume of Ringer's lactate required to maintain an arterial pressure of 50 mm Hg in both groups. Net fluid requirement was significantly (p< 0.05) less in postoperative septic sheep (47.4 ± 6.2 mg/kg/hr) treated with fibronectin-rich cryoprecipitate compared to the fluid requirement (71.7 ± 4.7 mg/kg/hr) for postoperative septic sheep receiving fibronectin-deficient cryoprecipitate. Thus elevation of plasma fibronectin concentration lowers the fluid requirements needed for hemodynamic support in postoperative Gram-negative sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study assessed the effect of burn trauma on the in vivo leukocyte cell delivery during the first 24 hr of the delayed type hypersensitivity (DTH) skin test reaction and a bacterial skin abscess. Inbred male Lewis rats sensitized to keyhole limpet hemocyanin (KLH) were given a 30% scald burn or sham burn. Three days later the animals were injected intradermally, at different sites, with 0.3 mg of KLH, 108organisms ofS. aureus502A, and 0.1 cc of saline, at 2 to 24 hr. Leukocytes labelled with Indium111oxine(leu111) were injected intravenously. In sham rats the peak leu111influx in the DTH reaction occurred at 2—4 hr while in the abscess it was biphasic with peaks at 3 hr and 6—8 hr. In burn trauma rats there was a markedly increased leu111peak at 2 hr in both the DTH and abscess reactions followed by a significantly lower than normal leu111delivery in the late (6—24) hours. This marked early leukocyte influx in burned rats was paralleled by a reduced DTH skin test lesion (8.2 ±1.1 mm to 4.2 ±1.1 mm) and an increased bacterial abscess (5.1 ±1.1 mm to 8.1 ± 0.9 mm) post burn. There was a direct correlation between leukocyte cell delivery to a DTH reaction and a bacterial abscess (r8=0.69, Spearman rank;p< .001). We conclude that burn trauma results in altered leukocyte delivery to inflammatory lesions and the DTH response can be used to assess the ability of a burn trauma host to recruit leukocytes at a site of infection.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The isolation and partial characterization of an immunosuppressive glycopeptide from sera of severely burned patients has previously been reported. Recently, a monoclonal antibody to this factor and an enzyme linked immunosorbent assay for detection of the peptide have been developed. The presence of the peptide in elevated quantity has been demonstrated in serum of patients with multiple blunt trauma as well as thermally injured patients. It was determined that the peptide is capable of suppressing neutrophil chemotaxis and T-cell blastogenesis as measured by MLR. Inhibition of B-cell blastogenesis induced by the peptide as measured by LPS mitogen-induced proliferation was demonstrated to be less sensitive to suppression. Further, it appears that activated T lymphocytes, those expressing increased IL-2 receptors, are more sensitive to suppression by the peptide at lower concentrations than are nonactivated T lymphocytes.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Thymuses of rats that had been: a) gamma-irradiated [500 cGy whole-body radiation (R)], or b) thermally injured [20% BSA dorsal, scald burn (TI)], or c) combined injured [irradiation followed by burn (CI)] were studied for involution and recovery processes after sublethal treatments. The expression of surfance antigens on thymic cells before and after injuried was evaluated using the monoclonal antibodies (mcAB) MRC OX4, MRC OX7, MRC OX8, W3/13 HLK and W3/25 and flow cytometric analysis. Thymic cellularity decreased to less than 1% of normal (N), age-matched rats by 4 days after R or CI. Recovery reached 60% to 70% of N by 28 days post treatments. TI caused a biphasic thymic recovery pattern with nadirs of 40% of N on days 7 and 21.n Recovery at day 28 was similar to that after R and CI. Expression of OX7, OX8, W3/13, and W3/25, was near completion by day 7 after R and CI. Changes in antigen expression after TI were less pronounced for all mcAB tested. Decreases in labeling of thymocytes with the helper T-cell marker, W3/25, observed after TI, could not be correlated with elevated expressions of the suppressor/cytotoxic T-lymphocytes antigen, OX8. Variations in relative labeling of nonlymphoid thymic cells with OX4 (Ia-antigen) reflected the disappearance and recovery of radiosensitive lymphoid thymocytes. The similarity of results after R and Ci demonstrate that the model of CI is ‘radiation-dominated.’ The addition of burn injury to radiation trauma had no synergistically damaging effect on the parameters studied.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) > 15, or emergency-room Trauma Score ≤14, or injuries requiring >3 days hospitalization, or death. With the addition of specific mechanisms of injury (auto vs. pedestrian accident at >5 m.p.h., motor vehicle accident at >40 m.p.h., motorcycle accident at >20 m.p.h., or a major assault), the sensitivity of a field Trauma Score of <14 could be improved from 45% to 75%, with a reasonable specificity of 40%. With these same mechanisms, the sensitivity of a CRAMS scale of ≤8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Lower torso ischemia and reperfusion has been shown to stimulate the generation of thromboxane (Tx)A2, leading to transient pulmonary hypertension and later to polymorphonuclear leukocyte accumulations in the lungs. This study investigated whether hind limb ischemia leads to increased pulmonary microvascular permeability. Anesthetized sheep (n=6) previously prepared with a lung lymph fistula underwent 2 hr of tourniquet ischemia of both lower limbs. One minute following tourniquet release mean pulmonary arterial pressure (MPAP) rose from 14 ± 1 to 36 ± 4 mm Hg (p < 0.05) and returned to baseline within 30 min. The pulmonary arterial wedge pressure of 4 ± 1 mm Hg was unchanged. Plasma TxB2levels rose from 211 ± 2 1 to 304 ± 52 pg/ml (p< 0.05) 10 min after tourniquet release and were back to baseline at 30 min. Lymph flow (QL) rose from 4.3 ± 0.6 ml/30 min to 8.3 ± 1.8 ml/30 min (p< 0.05); the lymph/plasma (L/P) protein ratio rose slightly but not significantly. In three sheep, inflation of a left atrial balloon increased left atrial pressure from 3 to 16 mm Hg. MPAP rose from 14 to 24 mm Hg. There was an increase in QL from 3.6 to 17 ml/30 min; the L/P protein ratio declined from 0.63 to 0.41. These results indicate that reperfusion following 2 hr of bilateral hind limb ischemia results in increased pulmonary microvascular permeability.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Another study documented that percutaneous transtracheal ventilation with a special 3.5-mm I.D. cannula was possible in experimental complete upper airway obstruction (CAO) using Ambu-assisted ventilation. The effects of ventilation during CAO by occlusion of the endotracheal tube was evaluated by use of a portable oscillatory pressure device (POPD) attached to a 10-g (I.D. 2.4 mm) angiocath catheter inserted through the tracheal wall. Eight pigs were anesthetized and ventilated with the POPD for 15 minutes after CAO with a mean peak airway pressure of 14 cm H2O and continuous positive airway pressure of 5—7 cm H2O, tidal volume below 100 ml, and a rate below 0.5 Hz. A Venturi delivered an FIO2of 0.68—0.92. All eight showed markedly stable blood gases and cardiovascular parameters (heart rate and systemic and pulmonary arterial pressures). A similar trend was obtained in a separate group of four pigs ventilated with an Ambu bag for 30 minutes; however, the PO2was lower. In the control group, asphyxia after CAO produced cardiorespiratory failure in every animal in less than 6 minutes. Lowfrequency ventilation with a POPD for CAO ensures adequate gas exchange using a standard transtracheal catheter of only 2.4 mm I.D.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study was designed to assess the accuracy of the urine dipstick and its ability to predict injury to the urinary tract when compared to routine urinalysis: 1,485 patients had dipstick and microscopic urinalysis performed as part of their evaluation for blunt and penetrating trauma. Dipstick analysis was recorded as either positive or negative. Microhematuria was defined as greater than 0—1 RBC/HPF on microscopic analysis.Blunt trauma accounted for 1,347 (91%) of the patients and penetrating injuries accounted for 138 cases (9%): 1,209 (81.4%) of the specimens were dipstick negative, and 276 (18.6%) were dipstick positive. False negative results, consisting of a negative dipstick reading and greater than 1 RBC/HPF on microscopic analysis occurred in 100 (6.9%) of the cases. False positive dipstick readings occurred in 64 (4.3%) of the patients. There were no cases of a missed injury in the group of 100 false negatives. Cost savings by conversion to the use of dipsticks would have saved our institution about $63,000 per year.It is concluded that the urinary dipstick is a safe, accurate, and reliable screening test for the presence or absence of hematuria in patients sustaining either blunt or penetrating abdominal trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

When considering the kinetic energy formula (KE=½ MV2) to estimate wounding potential of bullets, bullet velocity has assumed the premier role as the determinant of wounding capability. Particular characteristics of the bullet such as mass have assumed positions of secondary importance or have been largely ignored. In recent years, however, important changes in bullet design have occurred that can markedly change the character of gunshot wounds. Dum-dum bullets, hollow-points, shot shells, and explosive bullets have been designed so as to cause delivery of greater kinetic energy to the victim. Surgeons managing gunshot wounds must be familiar with these types of bullets in order to properly care for the victims and to ensure their own safety during the process.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID