ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Thirteen baboons were bled into shock and maintained at 60 mm Hg and 40 mm Hg for 2 hours, respectively, followed by resuscitation with shed blood and Ringer's lactate. In eight animals restoration of baseline left atrial pressure (LAP) was considered complete resuscitation and was maintained at baseline values with infusion of Ringer's for 18 hours. Five animals were resuscitated to baseline mean arterial pressure (MAP) and maintained with Ringer's. Complete hemodynamic parameters were recorded preshock, during shock, and hourly post-resuscitation for 18 hours. Organ blood flow was measured from radioactive microsphere injections at baseline, during shock, and 2 and 18 hours post-resuscitation. Blood volume was determined (Evans' blue) at baseline and 18 hours.Characteristic hemodynamic changes were noted with shock which returned to normal for the 18 hours post-resuscitation. Animals resuscitated to baseline MAP remained stable with additional small volumes of Ringer's whereas, using LAP as the parameter for resuscitation, increasing fluid requirements to maintain LAP, began at 3 to 4 hours and was paralleled by a corresponding increase in urine output. At 18 hours intake was 450 cc/hour and output nearly 350 cc/hour (both ≃ 4 times baseline). Organ blood flow altered as expected during shock and at 18 hours persistent, significant (p< 0.05) reduction in organ blood flow was noted in the splanchnic circulation (gut and spleen) in both groups. Blood volume was significantly below baseline (< 90%) at 18 hours.The data suggest a persistence of a teleologically important mechanism to protect the organism during shock which is not shut off by effective resuscitation as judged by hemodynamic criteria. Furthermore, the excessive fluid intake and output necessary to maintain baseline LAP suggest resetting of normal mechanisms for regulation of blood volume, and LAP may then not be a reliable parameter of resuscitation from hemorrhagic shock. These observations describe a prolonged abnormality in blood volume and flow distribution which may contribute to the syndrome of multiple organ failure following resuscitation from shock.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Of fatally injured patients with non-CNS injuries reaching the ER alive in an entire state from 1975–1979, 22% were judged to have potentially survivable injuries. A previous study from 1969–1974 in the same state of fatally injured abdominal injury patients showed 26% potential survivors. Errors in initial volume replacement, airway-respiratory control, and in the recognition of surgical urgency stand out in the present series.Review of these cases suggests that stabilization and resuscitation are necessary before transfer and that bypass to a regional trauma center would not have been likely to be effective in such a rural state.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

BB and pellet weapons are not included in gun control laws and are often sold as children's toys. Injuries caused by these weapons have been considered trivial unless they involve vulnerable surface organs such as the eye. The purpose of this study was to review the management of six cases of pellet or BB gun injuries that required abdominal exploration at the University of South Alabama Medical Center from January 1980 through June 1982. Five of the six patients had significant internal injuries including perforations of the stomach, jejunum, liver, and pancreas. The ballistics of pneumatic weapons are reviewed. The muzzle velocities of many of these weapons necessitate that wounds caused by these weapons be handled with the same principles as for any small-caliber, low-velocity (less than 1,200 feet/second) weapons.Public education programs are urgently needed to educate parents as to the potential danger involved in purchasing these weapons for unsupervised use as toys by children.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The results of emergency room thoracotomy (ERT) and cardiorrhaphy for 91 patients with penetrating cardiac injuries admitted in extremis to Lincoln Medical and Mental Health Center from 1963 to 1981 are reviewed to determine criteria for selection of patients for this procedure. Four groups were defined based on the severity of the effects of their injuries. The survival rates were 32.1 and 33.3%, respectively, for Group I (‘fatal’) and Group II (‘agonal’) patients. There were no survivors in Group IV (‘D.O.A.’) patients for whom ERT is a fruitless procedure. Survival in Group III (‘profound shock’) patients was only 40%, which might have been improved if ERT had been performed without delay. We conclude that ERT is essential for patients with ‘fatal’ and ‘agonal’ wounds and advise prompt ERT for patients in ‘profound shock’ who do not respond immediately to rapid volume infusion.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Physiologic profile monitoring was performed on 18 elderly patients (mean age, 71.3 ± 11.7 years) with major burns (mean, 49% ± 17% BSA) on days 1 to 4. Nine had associated inhalation injury. Ten patients survived more than 10 days. Degree of myocardial dysfunction in response to burn injury is unpredictable. Sixteen of the total 18 patients needed inotropic support. Cardiac output is probably a more accurate means of assessing efficacy of resuscitation than hourly urine output. Maintenance of cardiac index at higher than normal levels is a physiologic necessity. Failure of cardiac index to remain high after 3 days predicted nonsurvival in this group of patients. In presence of combined cutaneous and inhalation burn injury fluid requirement is unpredictable, and the optimum resuscitation in these patients merits further definition. Physiologic profile monitoring in these older patients is a very useful guide to the precise management of fluid resuscitation, early detection, and treatment of ventricle dysfunction, and results in improved survival.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Following splenectomy (SPLY) there is increased retention in the lung of injected particulate matter and an increased mortality from sepsis in experimental animals. Since it has been shown that autotransplanted splenic tissue (AST) decreased elevated pulmonary particulate retention after SPLY and improved the survival of animals following SPLY and sepsis, we attempted to determine whether the protective effect offered by AST was specific to the spleen. To determine this, four groups of rats were studied: Group I—sham; Group II—SPLY; Group III—received 100 mg of heterotopic AST in an omental pocket after SPLY; and Group IV—received 100 mg of heterotopic muscle tissue from the abdominal wall (AMT) in an omental pocket after SPLY. Six days after the above procedure, reticuloendothelial (RES) function was evaluated. The results indicate that both AST and AMT significantly decrease the abnormal pulmonary retention of particulate matter than the AST group. Survival following sepsis was studied in other animals from Group I, II, III, and IV. At 7 days after the original operation, the cecum was ligated and punctured (CLP) and then removed 16 hours later. The splenicas well as muscle-implanted animals showed significantly higher survival rates than the splenectomized animals. We therefore conclude that survival after SPLY can be improved by implanting either a fragment of the spleen or the muscle in the omental pocket. Since both tissues appeared necrotic at 7 days following implantation, the decreased pulmonary particulate retention and improved survival following SPLY and sepsis appear to be due to the presence of a necrotic tissue irrespective of its origin. These results suggest that the early effect of an implanted tissue is a nonspecific stimulation of phagocytosis.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Forty-two patients with pilon fractures were followed 24 to 96 (mean, 53) months post-fracture. Fractures were classified as Type I (26%), Type II (29%), or Type III (45%) as defined by Ruedi and Allgower. Type I fractures were usually torsional in nature whereas Type II and III injuries were usually the result of a fall from a height or motor vehicle accident. Type I and II pilon fractures were amenable to anatomic open reduction and stable internal fixation and 80% or more had satisfactory results. Only 44% of Type III fractures treated by open reduction and internal fixation produced a satisfactory outcome. Nonanatomic reduction, unstable fixation, infection, nonunion, and/or angulation were the usual causes of failure of this form of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fourteen thermally injured patients with severe inhalation injury were sequentially studied with the thermal-green dye double indicator dilution technique of extravascular lung water (EVLW) measurement. Eight females and six males (average age, 49 years, and average thermal burn, 37% body surface) were studied for 2–31 days postinjury. All were burned in a closed space, had facial burns, soot in their sputum, and a mean carboxyhemoglobin level of 30%. Nine patients died, six of sepsis, one each of acute renal failure, hepatorenal syndrome, and anoxic brain damage. Mean EVLW on admission was 7.0±2.9 ml/kg and remained normal in the five survivors and in the patients dying of acute renal failure and anoxic brain damage. Six patients had increases in EVLW, caused by altered pulmonary capillary permeability in five and by elevation of hydrostatic pressures in one patient (hepatorenal death). Of the five patients with permeability edema, one appeared to result from a direct early effect of inhalation injury resulting in an EVLW of 13.3 ml/kg on admission. The other four patients had EVLW increases after the onset of sepsis, resulting in a mean EVLW of 23.2±7.2 ml/kg at death (pWe thus conclude that increases in EVLW after thermal and inhalational injury are primarily caused by systemic or pulmonary sepsis, and have a delayed onset. Early increases in EVLW may be a result of the chemical toxicity of inhaled gases but are very uncommon, moderate in degree, and are seen only with the severest cases of inhalation injury.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Enteral feeding with 25% dextrose-4.25% Freamine II (TPN) improves the survival of malnourished animals to normal levels after hemoglobin-E. coliadjuvant peritonitis, whereas intravenous feeding does not. To determine whether intravenous feeding maintained a high survival rate in previously well-nourished animals, 81 rats received TPN via gastrostomy or intravenous infusion for 12 days. They were then fasted for 24 hours and given a septic challenge. Gastrostomy-fed animals survived the challenge significantly better than intravenously fed animals. Enteral feeding appears to be important in producing a high survival rate after hemoglobin-E. coliadjuvant peritonitis.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID