ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Sixteen patients with massive burns (exceeding 50% of total body surface) were treated at the University of California—Davis Burn Center in the period of 1980 and 1981. Fifteen had flame burns, and eight had inhalation injuries. Mean burn size was 72% total body surface (range, 51–94) with 20–81% full thickness. Mean age was 27 years. Survival results were compared with a similar group of 13 patients treated in 1978 and 1979, mean age 25, and burn size 65% total body surface. Fifteen of the 16 survived, compated with six of 13 in the early group. Substantial changes in therapy between the time periods resulted in the improvements. These include: 1) early endotracheal intubation with application of PEEP before evidence of pulmonary dysfunction; 2) elimination of Swan-Ganz and central venous lines for early volume resuscitation unless absolutely necessary; 3) the addition of hypertonic saline and protein infusions during the first 24 hours of resuscitation along with Ringer's lactate alone resulting in 30% decrease in fluid requirements; 4) rapid institution of nutritional support beginning by day three using a combination of peripheral hyperalimentation and tube feeding; 5) early eschar excision and grafting beginning in the first week rather than the second or third week as previously practiced. Septic complications and hospital stay were also decreased. Cadaver skin or artificial skin were unavailable. A significant improvement in survival rate was noted after a more aggressive treatment protocol was instituted.

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:

Determination of depth of burn injury using vital dyes has been unsatisfactory. The present study evaluated the ability of the fiberoptic perfusion fluorometer to assess the depth of burn in the early postburn period. Sixty-three burns were examined with the fluorometer after intravenous administration of sodium fluorescein. The fluorescein kinetics were monitored for 1 hour within the first 48 hours and again between the third and sixth days postburn. The rate of fluorescein uptake and burn wound fluorescence was determined and compared to that of normal unburned skin. Depth of burn was confirmed by biopsy and healing characteristics. Fluorometric analysis during both study periods consistently distinguished between partial-thickness and full-thickness burns. Partial-thickness burns uniformly exhibited fluorescence within 10 minutes; full-thickness burns showed nil fluorescence. None of the patients experienced a change in skin color or complications from the small dose of fluorescein given.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The mortality from abdominal vena cava trauma remains in excess of 33% despite advances in prehospital and intraoperative care. During the 7-year period ending December 1981, 58 patients with vena cava injuries were treated at our institution. Thirty-nine (67%) were due to gunshot wounds, nine to stab injuries, and ten to blunt trauma.Overall mortality was 38%. Predictors of poor survival were: 1) presence of shock upon hospital arrival; 2) multiple abdominal vascular injuries; and 3) injuries in the retrohepatic segment. Only two (17%) of 12 patients survived retrohepatic wounds despite various shunting techniques. Of the remaining 12 deaths, 11 (92%) had associated major vascular trauma that included four portal system, three aortic, and three iliac artery injuries. This contrasts to a 96% survival rate for the 28 patients without associated abdominal vascular injuries.Our experience underscores the importance of rapid resuscitation, early operation, and searching for associated vascular injuries before a time-consuming repair of the vena cava is undertaken. Improving the survival of patients with blunt retrohepatic cava and hepatic vein trauma remains a dilemma.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In 5 years, 267 patients with cardiopulmonary arrest after trauma were treated at our institution. The long-term survival rate was 2.6%. Only 1.5% of the 267 patients were functional individuals. Overall, neither the mechanism of injury nor routine emergency thoracotomy influenced the salvage rate. Our results in the management of trauma victims without vital signs indicate that: 1) among blunt trauma patients, those with isolated head injury have the highest survival rate; 2) patients with blunt multisystem injuries involving the chest, abdomen, or truncal orthopedic structures are unsalvageable; 3) cardiopulmonary arrest with penetrating head or neck wounds is a lethal combination; and 4) with the exception of patients sustaining penetrating chest or heart injuries, emergency thoracotomy does not enhance the survival rate of trauma patients who were formerly declared ‘dead on arrival.’

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine if concentration of plasma arginine vasopressin (AVP) is inappropriate for the plasma Na+concentration in hyponatremic burned patients, we obtained 32 plasma samples from 20 patients with total burn size (TBS) 15 to 80% of body surface on or after postburn day (PBD) 4 in the morning following all-night recumbency. In the 25 samples (17 patients) with hyponatremia, AVP was elevated, 1.6 to 14.3 (normal < 0.5) pg/ml. Most patients with normal serum Na+had normal AVP values. Out of the total, nine patients (12 samples) without renal failure or sepsis, selected also for hyponatremia and urinary Na+≥ 20 mEq/L, were considered separately. BUN of 11.7 ± 1.8 mg/dl and plasma glucose of 130 ± 5.6 mg/dl, Na+of 130 ± 1.1 mEq/L, calculated osmolality of 272 ± 1.6 mosm/kg, and cortisol of 20.4 ± 1.6 μg/dl were associated with a 24-hour fluid intake of 4.3 ± 0.26 L and urinary output of 2.7 ± 0.33 L, Na+of 80 ± 14 mEq/L, and osmolality of 520 ± 73 mosm/kg (mean ± SE). In all of the plasma samples, AVP was markedly elevated (6.9 ± 1.1 pg/ml). In another study, four hyponatremic burned patients were given a standard water load. Excretion of the water was delayed, and further dilution of the initially hypotonic plasma resulted in a fall of urinary osmolality and plasma AVP. Cutaneous thermal injury can cause resetting of the mechanism linking plasma tonicity and AVP secretion resulting in dilutional hyponatremia. This syndrome occurs in the absence of gross physiologic perturbations such as volume depletion or adrenal insufficiency.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Endotoxin (LPS) exposed to 100–200 kGy of γ radiation no longer induced rabbit platelet aggregation in vitro and it had a reduced ability to cause mitogenesis of B-lymphocytes from C57BL/6 mice. When tested in B6CBF1 mice exposed to 10 Gy60Co radiation 3 or 7 days previously, 300 μg of unirradiated LPS, which caused no mortality in unirradiated mice, killed 60 and 44% of the mice when given on days 3 or 7 post-radiation, respectively. Similarly, 60% of C57BL/6 mice engrafted with 5 × 106Lewis lung carcinoma cells 3 days before challenge with 300 μg of normal LPS died, but no animals given irradiated LPS died.One hundred micrograms of either LPS preparation caused 80 to 100% mortality of NMRI mice when given simultaneously with 105liveK. pneumoniae. No deaths were obtained if 50 μg of irradiated LPS were administered with 105bacteria, but 50 μg of unirradiated LPS caused 100% mortality. Similar mortalities were obtained when 100 μg of either toxin preparation were given 24 hr postinfection, but these were lower than those obtained with the simultaneous challenge. Endotoxin given 24 hr before 105organisms was less toxic than that given at the other times, and irradiated LPS caused fewer deaths than did unirradiated LPS. Similar results were seen when 106cells were used to challenge mice. Treatment 24 hr before challenge caused 70% mortality with unirradiated LPS compared to 30% mortality with irradiated LPS. All mice challenged with 107bacteria 24 hr after treatment with saline or unirradiated LPS died by 72 hr postinfection, but only 50% mortality was obtained in mice given irradiated LPS. Furthermore, none of these mice died until after 72 hr.Our data indicate that under some circumstances irradiated LPS can be more safely administered to animals with compromised resistance than can unirrudiated LPS.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The establishment of immediate venous access and rapid fluid administration remains of paramount importance in the treatment of hypovolemic shock. We describe a technique for placement of a recently available 10-gauge catheter via venous cutdown. This technique is simpler and quicker than placing intravenous tubing directly into the vein, and we show that flow rates through the catheter with both saline and blood are equivalent to rates obtained through intravenous extension tubing. In addition, our studies show that the use of wide-bore intravenous tubing (urology irrigating tubing) instead of standard intravenous tubing allows for much higher infusion rates through the 10-gauge catheter. With the wide-bore tubing and pressure infusion, it is possible to administer 1,200 cc of blood per minute through this catheter.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In 44 patients neck wounds penetrating the platysma were evaluated over a 5-year period. Twenty-one patients were admitted and observed; 22 patients were explored immediately. One was dead upon arrival in the emergency room. The decision to explore was based upon initial clinical evaluation using criteria of unstable vital signs, bleeding, hematoma, subcutaneous emphysema, respiratory distress, or neurologic deficits. Of the 21 patients selected for observation, none had complications or required later surgery. There was a negative exploration rate of 23%. Had all patients been explored, the negative exploration rate would have been 60%. We conclude that selective exploration, based upon careful clinical evaluation, is both safe and reasonable in cases of penetrating neck trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID