摘要:

A series of dogs was given massive fluid infusions at two dose levels, 60 cc/kg and 100 cc/kg. The dogs were prepared in three ways: shock induced by bleeding; intravenous injection of oleic acid; and combined oleic acid injection and shock. The studies showed that type of injury was a more important determinant of lung dysfunction than the fluid dose. Shock animals were not hurt by fluid infusion; in oleic acid-injected dogs, the fluid infusion magnified the effect of oleic acid. When shock, oleic acid, and high fluid dose were combined, all animals died. The animals that died had high pulmonary artery diastolic pressures.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Previous studies have shown myocardial depression to occur secondary to toxic extracts of burned mouse and human skin and secondary to toxins present in acute human burn serum. The present report describes myocardial depression in an arterially perfused rabbit interventricular septum as a result of toxins present in acute burn plasma.New Zealand white rabbits subjected to a 25% BSA full-thickness burn were heparinized and exsanguinated 2 hours postinjury. Cellular elements and plasma were separated and the plasma frozen.Rabbit myocardial septa were then perfused with normal or burn plasma. Rabbit red cells were added to restore hematocrit to 20°, and the plasma-red cell mixtures were equilibrated with 98% O2+ 2% CO2. Temperature (28°C), pH (7.40), and flow rate (1 ml/min) were constant for all trials.All normal plasma preparations showed an improvement in developed tension (DT) during the 30-60 minute perfusion period with mean % change = + 10.5. A corresponding increase in dP/dt was also noted for all normals (mean % change = + 14.3); all septa perfused with acute burn plasma showed a decline in myocardial performance during a similar perfusion period. Mean % change in DT for burn plasma preparations was − 57.5, and in dP/dt for these septa was − 59.5.Significant myocardial depression occurs in arterially perfused rabbit septa when acute burn shock plasma is used as the perfusate.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Despite the emphasis on appropriateness of emergency department utilization, there is currently no methodology for assessing appropriateness nor measures for a community to evaluate and improve effectiveness of its E.M.S. system in treating emergencies at the appropriate emergency room and nonemergencies at appropriate alternative settings. The writer feels that the one current strategy which is widely accepted, the A.M.A.'s concept of categorization, has substantial methodologic limitations. The present paper suggests a methodology and a set of measures to assess appropriateness of utilization and illustrates them with data from Buffalo, New York, on a chart review of 24,594 emergency department patient medical records and interviews with 888 patients and their attending physicians. The measures include: 1) distribution of ambulance and critically ill patients by A.M.A. category of hospital, 2) utilization, characterized as system under- or over-response or as appropriate utilization, and 3) physician judgments as to indicated alternative treatment sites, which are suggested as evaluative tools to hospital and communities for E.M.S. assessment, and to federal and state agencies as performance standards, for project selection for funding and monitoring for outcome evaluation.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Allegedly toxic heme pigments have been described in the serum of animals bled to hemorrhagic shock (5, 7). In addition, Sears et al. (9), and Braun et al. (1) have shown that the products derived from the degradation of hemoglobin following intravascular hemolysis were toxic (heme carried by hemopexin and albumin).The accumulation of metabolites, caused by the impeded circulation, degrades free hemoglobin into heme pigments and their concentration then reaches a level which exceeds the normal heme-carrying capacity of serum proteins. We have already demonstrated the presence of abnormal heme pigments in clinical cases of shock using scanning spectrophotometry (3). We have endeavored to identify these pigments by serum electrophoresis, and to relate the appearance of some of these compounds to mortality rates. There were no deaths associated with the presence of haptoglobin-hemoglobin alone in serum. As shock deepened and mortality rose, hemopexin-heme and methemalbumin appeared. The highest mortality rate (4 out of 5 cases) was found when both hemopexin-heme and methemalbumin were present. It appears, therefore, that the administration of serum proteins in shock may reduce the toxicity of the products of degradation formed in low-flow states.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Following severe multiple trauma, decreases were observed in a) Free cholesterol, b) Cholesteryl esters, c) Total phospholipids, and d) Lysolecithin. Comparatively slight changes in coagulation parameters did not differ regardless of whether pulmonary complications developed. In contrast, increased fibrin lipid complexing was more closely correlated with clinical data, because: a) Plasmatic lipids, particularly triglycerides complexed with fibrins, were elevated severalfold in patients with adult respiratory distress and fat embolism syndromes when compared with multiple trauma patients without pulmonary complications. This was independent of plasma lipid levels. b) Plasmatic triglycerides complexed with fibrins were significantly higher in patients who died than in those who survived. The considerable changes in the plasma lipid pattern following severe trauma suggest the presence of an abnormal lipoprotein with increased affinity to fibrin, thereby inhibiting fibrinolysis. This might well be one pathogenic mechanism in the development of post-traumatic respiratory distress syndrome.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

One hundred consecutive cases of trauma with associated fractures of the lower limb long bones were studied for the subsequent development of the fat embolism syndrome (FES). This is to be differentiated from the intravascular fat embolism which often occurs without clinical FES becoming manifest. Seventeen of the patients developed the clinical picture, with a further 16 patients being considered to have had the syndrome subclinically. Clinical and biochemical features were studied to determine pointers to the early diagnosis and patient “at risk” of developing FES. Young males under the age of 30 with significant hypoxemia occurring early in the course of the disease were considered the most likely candidates “at risk” for developing FES. These results favor the concept that FES is essentially a form of respiratory insufficiency syndrome similar to that which occurs following trauma in other situations, e.g., shock lung.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Burn wound edema is a source of major morbidity and mortality. To quantitatively study this edema, we have devised a noninvasive method called Dichromatic Absorptiometry (DA) which is precise (2-3%) and accurate (r=0.99) in measuring changes in tissue fluid. A scanning technique using a dual photon source,125I and241Am, is used. The variable attenuation of the two photon energies allows for selective mass measurements of fluid, protein, lipid, and bone. In limbs with thermal injury the correlation of DA changes in fluid mass with circumference was (r=0.97), but DA was more sensitive. In deep second- and third-degree burns, edema formation was maximum between 12 and 18 hours postburn with 80% of maximum already present at 4 hours. Resorption was complete by 1 week in second-degree burns, but significantly delayed in third-degree burns. Superimposed infection produced persistent edema.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Complement system has been investigated in the first 15 days postburn. Complement titer (measured by a kinetic method of immune hemolysis) decreases immediately after thermal injury. This depression is mainly explained by mechanical leakage and is related to burn surface. No anticomplementary effect has ever been found in this period. After 48 hours complement titer rises. Magnitude and rate of rise are inversely related to the severity of burn trauma (depth and surface). Infection occurrence is statistically related to but somewhat independent of complement levels and interferes with the rate of increase of complement levels. The basis of the rise to normal or elevated complement levels remains unexplained.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID