ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Comprehensive cardiopulmonary and metabolic monitoring of severely traumatized patients for 7 days from the time of injury has allowed us to determine parameters which correlate with survival and nonsurvival. The earliest and most persistent change is an increased pulmonary vascular resistance which results in right heart overload and failure. Left heart “failure” which has been previously described with acute respiratory failure and shock is shown to be a mathematical artifact caused by dilatation of the right heart and encroachment on left ventricular filling volume. Causes of death in most patients were not directly referable to right heart dysfunction but we postulate that hypercoagulability and microembolism could independently produce the observed pulmonary vascular changes as well as the multiple organ failure which usually was responsible for death. Resolution of this question will require more sophisticated hematologic evaluation.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The hospital records of 540 consecutive patients with hepatic trauma were reviewed. Persistent arterial bleeding from hepatic wounds was encountered in approximately 10% of severe liver injuries. Compression of the porta hepatis will result in cessation of bleeding in such patients and subsequent ligature of the appropriate lobar artery will provide permanent, safe control of bleeding. Failures of selective hepatic artery ligation commonly result from incomplete diagnosis of the extent of injury to portal veins and hepatic veins.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

For 8 years biweekly ambulance critique review sessions have evaluated performance and discussed management of cases brought to our hospital by ambulance. Over 500 cases reviewed have centered primarily on evaluation and care at the scene and its possible relation to outcome.Problems which have recurred on the scene include whether the patient would have benefited from less time in stabilization and immobilization; manipulation of deformed fractures for splinting; use of tourniquets; techniques of airway maintenance; and management of infrequently seen problems such as hypothermia and drowning.Interaction problems with physicians on the scene and in the Emergency Room (ER) come from questioning physician authority even without specific knowledge of the appropriate techniques of emergency care. A related problem is lack of ER staff familiarity with Emergency Medical Technician (EMT) procedures and ambulance equipment.The value of critique review sessions has been seen in improved rapport and interaction among ER staff and ambulance personnel. Improved outcome needs to be assessed in a carefully controlled study. The enthusiasm and attendance of ER staff and ambulance personnel has grown and endured over 8 years. The review sessions have spread to other area hospitals with some success.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Peritoneal lavage is an invaluable adjunct in the evaluation of abdominal trauma. Of 780 abdominal trauma patients in a prospective study, 685 underwent percutaneous peritoneal lavage. RBC counts in the effluent above 50,000/mm3corresponded well with findings at exploration; however, two thirds of the patients having counts between 20,000-50,000/mm3had serious injury at celiotomy. The data suggest the need for a reappraisal of lavage criteria for operation.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A 30-year experience with 321 wounds of the duodenum was reviewed. Of the total, 302 had some form of perforation; 19 had intramural hematomas. All patients underwent laparotomy shortly after admission except six cases of radiographically diagnosed submucosal hematoma. Occasional dehiscence of the duodenal suture line and its life-threatening complications (six of 52 cases, or 12%) led to a policy of routine duodenal decompression by gastrostomy plus twin jejunostomies in 1962. Following use of the latter technique in 237 patients, only one leak occurred. By contrast, failure to decompress had an 8% leak rate; direct drainage of the suture line gave an even greater incidence of dehiscence or fistula, 23%. Associated pancreatic injuries were treated as separate wounds by sump drainage or distal pancreatectomy. None of three patients subjected to pancreaticoduodenectomy for massive combined pancreatic and duodenal trauma survived. A long-armed T-tube was always inserted for recognized as well as suspected common duct wounds. Although most of the 41 deaths were due to major vascular trauma and sequelae of hemorrhagic shock, duodenal complications did contribute to significant morbidity and five mortalities during the earlier years of review.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Operative management of combined pancreatic and duodenal injuries has been a controversial subject in recent years. Methods advocated include resection, duodenal diversion, and simple repair and drainage. Excellent results have been reported with each of these, but most reported series are small, preventing definitive conclusions concerning the value of any treatment modality. During an 8-year period ending December 1976, 308 pancreatic injuries and 175 duodenal injuries were treated. Sixty-eight of the patients had combined pancreatic and duodenal injuries and constitute the basis for this report. Fifty-five patients sustained penetrating injuries and 13 had blunt injuries. Eighteen underwent repair and drainage. The remaining 50 required more extensive procedures which included duodenal diversion and pyloric exclusion in 32, pancreatoduodenectomy in six, and a variety of procedures in the remainder. The operative mortality rate was 26.4%, including five patients who died intraoperatively. In the entire series only one death was directly attributable to the pancreatoduodenal injury. We conclude that no single procedure is uniformly applicable to these injuries. Surgeons treating trauma of this severity should be familiar with a variety of techniques for repair, and treatment should be individualized. Preservation of tissue should be accomplished when possible.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The brainstem auditory evoked response (BAER) was evaluated as an aid in the early diagnosis and prognosis of 17 comatose blunt head-injury patients. Click stimuli (60 dBSL, 10/sec) were presented monaurally through headphones. BAER's were recorded between Cz and ipsilateral mastoid; contralateral mastoid ground. No BAER waves occurred in three “brain-dead” patients. Two patients with initially abnormal BAER's did not show improvement in followup recordings, and died of their brain injuries. Recovery occurred in 12 patients with normal followup BAER's, regardless of whether initial BAER's had been abnormal (three patients) or normal (nine patients). Apparently, initial BAER's (mean, 31 hours postinjury) can be abnormal as the result of reversible damage. Followup BAER's (3 to 6 days postinjury) did correspond with patient outcome at a time when clinical prognoses were often uncertain. BAER's aided diagnostically in determining the extent of brainstem damage and the effectiveness of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Complications are the major causes of illness and death after burning and most of them stem from the burn wound. Their origin and importance are reviewed with emphasis on problems and growing points in knowledge. Fluid leakage from the circulation into the burn is the cause of hypovolemic shock, but the underlying permeability changes in the burn are only partly understood. Other nonbacterial complications include acute cardiac failure, acute anemia, hemolytic jaundice, renal failure, encephalopathy, complex hypermetabolic effects including pseudodiabetes, gastric and duodenal ulceration, deep vein thrombosis and pulmonary embolism, pulmonary and glomerular microthrombosis, hepatic jaundice, and arterial thrombosis. Involvement of the airway in conflagrations carries special hazards like glottic edema and inhalation of irritant fumes. Nowadays, bacterial causes are dominant and these remain the main challenge. Bacterial infection and invasion of the burn are usually responsible for septicemia, bronchopneumonia, and pyelonephritis although other sources also contribute. Indirect manifestations of septicemia include paralytic ileus, acute gastric dilatation, toxic myocarditis, and some cases of renal failure. Therapeutic complications like agranulocytosis, thrombocytopenia, and colitis occur at times. High concentrations of oxygen given therapeutically can produce fatal aseptic hypoxic pneumonitis.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID