摘要:

BackgroundPrimary blast injuries are produced by the blast shock wave. The critical determinant of survival is pulmonary injury, but acute cardiorespiratory responses to blast exposure are not well understood. The aim of this study was to investigate these changes.MethodsTwenty anesthetized rats were exposed to moderate blast overpressure, 10 animals receiving thoracic and 10 receiving abdominal exposure. Another 9 animals acted as controls. Respiration, heart rate, and blood pressure were recorded continuously before, during, and for 6 hours after blast exposure.ResultsAll animals exposed to thoracic blast demonstrated apnea, bradycardia, and hypotension after blast exposure, followed by a return to preblast values. No significant cardiovascular or respiratory changes were seen in animals in the other groups.ConclusionModerate thoracic blast injury produces a reflex triad of apnea, bradycardia, and hypotension that is not present after abdominal blast. These observations may have important implications for the immediate management of patients with blast injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study investigates whether factors that determine myocardial performance (preload, afterload, heart rate, and contractility) are altered after isolated unilateral pulmonary contusion.MethodsCatheters were placed in the carotid arteries, left ventricles, and pulmonary arteries of anesthetized, ventilated (FiO2= 0.5) pigs (31.2 +/- 0.6 kg; n = 26). A unilateral, blunt injury to the right chest was delivered with a captive bolt gun (n = 17) followed by tube thoracostomy. To control for anesthesia and instrumentation at FiO2of 0.5, one group received tube thoracostomy only (sham injury; n = 6). To control for effects of hypoxia without chest injury, an additional sham-injury group (n = 3) was ventilated with FiO2of 0.12. To generate cardiac function (i.e., Starling) curves, lactated Ringer's solution was administered in three bolus infusions at serial time points; the slope of stroke index versus ventricular filling pressure defines cardiac contractility.ResultsBy 4 hours after pulmonary contusion, pulmonary vascular resistance, airway resistance, and dead space ventilation were increased, whereas PaO2(72 +/- 6 mm Hg at FiO2= 0.5) and dynamic compliance were decreased (all p < 0.05). Despite profound lung injury, arterial blood pressure, heart rate, cardiac filling pressures, and output remained within the normal range, which is inconsistent with direct myocardial contusion. The slope of pulmonary capillary wedge pressure versus left ventricular end-diastolic pressure (LVEDP) regression was reduced by more than 50% from baseline (p < 0.05), but there was no significant change in the slope of the central venous pressure versus LVEDP regression. By 4 hours after contusion, the slope of the stroke index versus LVEDP curve was reduced by more than 80% from baseline (p < 0.05). By the same time after sham injury with FiO2of 0.12 (PaO (2) < 50 mm Hg), the regression had decayed a similar amount, but there was no change in the slope after sham injury with FiO2of 0.5 (PaO2200 mm Hg).ConclusionAfter right-side pulmonary contusion, the most often used estimate of cardiac preload (pulmonary capillary wedge pressure) does not accurately estimate LVEDP, probably because of changes in the pulmonary circulation or mechanics. Central venous pressure is a better estimate of filling pressure, at least in these conditions, probably because it is not directly influenced by the pulmonary dysfunction. Also, ventricular performance can be impaired by depressed myocardial contractility and increased right ventricular afterload even with normal left ventricular afterload and preload. It is thus conceivable that occult myocardial dysfunction after pulmonary contusion could have a role in the progression to cardiorespiratory failure even without direct cardiac contusion.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundBlunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined.MethodsThe institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient.ResultsTwenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge.ConclusionBHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether computed tomography (CT) is an accurate diagnostic modality for the triage of hemodynamically stable patients with gunshot wounds of the abdomen and flank.MethodsA chart review of 83 trauma patients for whom abdominal CT was used as initial screening.ResultsIn 53 patients, CT revealed no evidence of peritoneal penetration, and in 15 patients, there was evidence of either peritoneal penetration or liver injury. There were no false results in these patients. Among 15 patients with questionable peritoneal penetration, cavitary endoscopy was performed in 11 and exploratory laparotomy was performed in 3, and 1 patient was initially observed and subsequently underwent exploratory surgery for a missed colonic injury.ConclusionIn selected centers and in hemodynamically stable patients with abdominal and flank gunshot wounds, abdominal CT can be an effective and safe initial screening modality to document the presence or absence of peritoneal penetration and to manage nonoperatively stable patients with liver injuries. If there is any question of peritoneal penetration, cavitary endoscopy should be part of the protocol of nonoperative management.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTraumatic rupture of the thoracic aorta is recognized as a common cause of occupant death after rapid deceleration in motor vehicle collisions. The incidence of thoracic aorta rupture in pedestrian victims of vehicular collisions, however, is unknown. This study focuses on the epidemiology of injury to the thoracic aorta in pedestrian vehicular collisions.MethodsWe performed a retrospective analysis of all pedestrian fatalities and survivors of rupture of the thoracic aorta during a 6-year period at a regional Level I trauma center and medical examiner's office.ResultsThere were 220 pedestrian fatalities during the study period. Laceration of the thoracic aorta was noted in 28 of the 220 pedestrian victims (12.7%). Two additional pedestrians survived laceration of the thoracic aorta, for a mortality of 94%. Hospital mortality was 66% (4 of 6). The comparative hospital mortality for patients with rupture of the thoracic aorta secondary to motor vehicle collision was 42%.ConclusionThe incidence of thoracic aortic injury in pedestrian fatalities of 12.7% is comparable with previous reports of motor vehicle collision fatalities. Because of the presence of increased associated injuries, pedestrians have a significantly higher mortality. Severely injured pedestrians are at a similar risk to motor vehicle occupants for a life-threatening injury of the thoracic aorta.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundOperative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-through lung injuries that did not involve hilar vessels or airways. Pulmonary tractotomy has evolved into use as an abbreviated thoracotomy technique in patients with severe thoracic or multivisceral trauma. As with any operative technique in high-risk patients, specific procedure-related complications may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy.MethodsMedical records were retrospectively reviewed for 30 of 32 consecutive tractotomy patients treated at Ben Taub General Hospital, during a 3-year period. By using a model for logistic regression analysis, the characteristics of each patient and their clinical course were tested for impact on mortality.Results38.0 seconds), or hypothermia (core temperature < 34[degree sign]C), and 50% of patients manifested two of these three parameters. The mortality rate among the 30 patients was 17%. Three of the five patients who died were noted to be acidotic, coagulopathic, and hypothermic. Twelve of 25 patients who survived more than 1 day had at least one thoracic complication. There were no late deaths. There was one failed tractotomy and one missed injury. A second thoracotomy was not required for control of a lung injury in any patient. Logistic regression analysis showed that intraoperative blood loss was the only predictive factor for mortality.ConclusionPulmonary tractotomy is a simple and effective technique in injured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as definitive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundSevere simple hemorrhage (blood loss in the absence of tissue damage and nociception) leads to a reflex bradycardia and hypotension. Earlier studies showed that this reflex can be attenuated by prior administration of morphine. However, some patients may receive morphine, e.g., for analgesia after they have suffered severe hemorrhage. The aim of this study was to determine whether an established bradycardia and hypotension could be reversed by morphine.MethodsFour groups of male Wistar rats (236-258 g) were anesthetized with alphadolone/alphaxalone (16-19 mg[center dot]hg[center dot]h-1intravenously). All groups received a hemorrhage of 40% total blood volume (BV) at 2% BV[center dot]min (-1). After the loss of 27% BV, bradycardia and hypotension were established equally in groups I and II and III and IV. Groups I (n = 8) and III (n = 10) received 0.9% saline (20 [micro sign]L intracerebroventricularly or 1 mL[center dot]kg-1intravenously, respectively), whereas groups II (n = 10) and IV (n = 10) received morphine (10 [micro sign]g intracerebroventricularly or 0.5 mg[center dot]kg-1intravenously, respectively).ResultsIn groups I and III, heart rate and mean arterial blood pressure continued to fall, whereas the bradycardia was completely reversed and the hypotension partly reversed in groups II and IV after treatment with morphine.ConclusionMorphine, administered centrally or peripherally, can reverse the bradycardia and markedly can attenuate the hypotension associated with severe hemorrhage. However, any benefit may be more apparent than real because other studies suggest that mortality may be increased.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundThe acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries.MethodsParticipants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n = 80) had fractures only, group 2 (n = 28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior.Resultsgroup 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress.ConclusionPediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID