摘要:

Voltages from 10 to 14,000 volts demonstrate currents up to 70 amperes with resistances of approximately 200 ohms in studies in hogs. Below 1,000 volts, a current reduction is observed following arcing and skin necrosis. At the higher voltages, this phenomenon was not observed. The energy required for tissue damage was dependent upon the voltage and time of application. The tissue electrode resistance with stainless steel discs was proportional to the diameter. Skin burning commenced at the periphery of the electrodes and moved inwards. For application of currents between the hindlimbs of the hog, the current per tissue cross-section was greatest in artery and nerve, followed by muscle, fat, bone marrow, and bone cortex.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Previous studies have suggested that increases in extracellular osmolality mediate a shift of intracellular fluid into the interstitium following 10% hemorrhage. This unidirectional fluid movement is required for full restitution of blood volume (BV) and for cardiovascular stabilization. The extent to which this mechanism acts in larger hemorrhages was examined in these studies. Forty-two dogs were studied 3 weeks after splenectomy. Twenty were anesthetized with pentobarbital, the others were studied awake. Hemorrhages of 10% (7.5 ml/kg, 15 dogs), 20% (15 ml/kg, 13 dogs), and 30% (22.5 ml/kg, 15 dogs) were carried out over 3 minutes.Patterns of changes in osmolality, total plasma protein content, and blood volume were identical in the two groups, although osmolality was significantly greater during the first 2 hours in anesthetized dogs. Osmolality increased with increasing degrees of hemorrhage, providing an increasing driving force for fluid shifts. Restitution of BV was significantly greater after 20% hemorrhage than after 10% hemorrhage. However, restitution of BV after 30% hemorrhage was no greater than after 10% hemorrhage. Patterns of protein restitution paralleled changes in BV. Cunningham, Shires, and Wagner (7) reported fluid shifts into cells after a 30% hemorrhage associated with a fall in membrane potential. It thus appears likely that a fluid shift out of cells in response to increased osmolality is offset by shifts into cells as the magnitude of hemorrhage becomes large. This failure of homeostatic restoration of BV with consequent failure of cardiovascular stabilization may represent an early event in the development of hemorrhagic shock.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The effects of prolonged starvation on reticuloendothelial system (RE) function and on the survival of animals following trauma were studied. Rats were fasted for 51/2days (water ad lib) after which a two-cm midline incision was made and the cecum ligated (CL). Food and water were allowed 36 hr after CL and survival was measured over 5 days. The mortality rate in these animals was 60% (15/25) compared to 0% (0/15) in CL rats fasted for 24 hr. Starvation alone for 7 days did not produce any deaths but after 11 days of starvation mortality was 100%. Another group of animals were fasted for 5% days and were used to study RE function 10 hr following CL. There was no significant difference in the intravascular clearance rates of injected lipid emulsion in various groups of animals, indicating that total phagocytic function was not changed by prolonged starvation plus CL (SCL). However, emulsion retention in the spleen, expressed as per cent injected dose per gm tissue, decreased by 53% and the lung retention increased by 988% following SLC. Serum GOT levels were not affected by prolonged starvation alone; however, SCL resulted in its elevation (37 vs. 82 IU/ml). Hepatic ATP levels (μmoles/g) decreased from 2.47 to 1.95 following 51/2days starvation and following SCL, it decreased to 1.75. These results indicate that the increased metabolic demand following trauma (i.e., CL), coupled with prolonged starvation, alters RE function with splenic lipid emulsion uptake decreasing and pulmonary uptake increasing. The relationship of these findings to immune function remains to be determined. Although the precise cause of increased mortality is not known, altered metabolic and RE function may play a role.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Over 720 persons are reported to have died jumping from the Golden Gate Bridge. A review of 100 consecutive autopsies showed that, in the majority of cases, massive pulmonary contusion, pneumothorax, laceration or perforation of the heart, great vessels, or lungs by displaced ribs were the causes of immediate death. Irreparable fractures of the liver or spleen were the most common abdominal injuries. The persons fatally injured appeared to have entered the water in a horizontal position, experiencing maximal deceleration. In contrast, six survivors entered the water feet first with more gradual deceleration. These survivors remained conscious but sustained similar injuries of lesser degree; only one sustained rib fractures. Fifty per cent had fractures of the liver or spleen requiring operative therapy. Fifty per cent sustained lung contusions and subsequent pneumothoraces. Suspicion of underlying injuries to the liver, spleen, and lungs is essential during resuscitation of those who survive impact with water.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Management of acutely burned patients requires intense but meticulous fluid therapy. Indicators of satisfactory resuscitation include: intravascular and arterial pressures and urine output. The usefulness of these parameters as a predictor of cardiac index (CI) has not been tested. Compared to central venous pressure, right ventricular end-diastolic volume (RVEDV) may give a closer approximation of the preload of the right ventricle. Modifying the pulmonary artery (PA) catheter and using the thermodilution technique we measured RVEDV and right ventricular ejection fraction (RVEF) as well as the classical parameters in 16 patients of mean age 39.3 years and of mean body surface area burn 75.2%. CI best correlated with RVEDV (r = 0.75). Mean PA pressure, wedge pressure, RV end-diastolic pressure, and urine output correlated poorly with CI (r = 0.36, 0.32, 0.27, and 0.26, respectively). Unlike atrial pressures the RVEDV and RVEF are unaffected by malpositioning of transducers, airway pressure, and compliance changes of the ventricle. The measurement of RVEDV is a useful clinical tool for the assessment of preload and when used in combination with RVEF may indicate the need for inotropy.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

As part of an incidence study of external cause-specific trauma, the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are being used to measure the severity of the anatomic injuries. Problems identified in the study pilot phase by medical record specialists, after training in AIS procedures, include noteworthy variations in the interpretation of scaling procedures in the AIS dictionary.The AIS dictionary was replaced by a newly designed single page (SP) precoded abstracting form. It contains alphabetical descriptors for each trauma type within a body region and a unique 3-digit identifier assigned to each. The AIS severity codes are not mentioned on the form. Abstractors are instructed to code all injuries for an episode. A computer algorithm has been developed and implemented to assign the AIS severity codes.Accuracy and precision improved markedly by eliminating the need to make severity scoring decisions during the AIS coding process.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Experiments were conducted using non-enzymatic chemical agents (with emphasis on certain mercaptans), alone, in conjunction with enzymatic agents and/or other nonenzymatic chemicals for debridement of burns. Both in vitro (rats, pigs, humans) and in vivo (rats, pigs) tests were carried out. N-acetylcysteine, penicillamine and cysteine ethyl ester in low to moderate concentrations accelerate the debriding action of bromelain (an enzymatic preparation from pineapple stems) and in higher concentrations, N-acetylcysteine and penicillamine (cysteine ethyl ester was not tested) cause ready separation of the burn eschar from the underlying tissue before solubilization of the eschar is complete (rat) or has occurred (pig). Debridement of 3° burns of rats is complete within 4–6 hours; the take of immediately applied syngeneic skin grafts is complete and permanent. This is the first time rapid debridement of 3° burns permitting immediate successful skin grafting has been accomplished with known defined chemicals. In pigs there is softening of the 3° burn eschar by N-acetylcysteine but little, if any, dissolution of the eschar. However, mechanical separation of the eschar from the underlying tissue is accomplished readily with a wooden throat stick with no bleeding. There is a change in color of the superficial layer of the underlying subcutaneous tissue from yellow-light brown to dark brown-black. The debrided areas begin to granulate promptly. The healing of deep dermal burns of pigs is hastened by the application of N-acetylcysteine for a day (beginning 24 hours after burning) while the healing of moderately deep dermal burns is not modified. Unburned skin is not damaged. There is no apparent systemic toxicity associated with the use of N-acetylcysteine for debridement of 10–15% b.s.a. 3° burns of rats or 15–20% b.s.a. 3° burns of pigs. Major emphasis has been on N-acetylcysteine because of the potential adverse secondary effect of penicillamine and cysteine ethyl ester; N-acetylcysteine is readily metabolized. The use of a keratolytic agent prior to the application of N-acetylcysteine hastens the latter's action. Sulfamylon and sulfadiazine can be used with N-acetylcysteine without interfering with its debriding action. The effects of the mercaptans are likely due largely to their ability to depolymerize connective tissue proteoglycans and proteins, especially at the interface between living and dead tissue.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The correlations between the acute phase and nutritional plasma proteins and intravenous amino acid dosage have been explored in a group of 25 trauma septic patients of whom 14 survived. The two groups of patients appeared to have equal cardiopulmonary function and exogenous nutritional support. The surviving group showed significant associated changes (p ≤ 0.05) between α1acid glycoprotein, α2HS glycoprotein, and ceruloplasmin (acute-phase proteins) and between prealbumin, retinol-binding protein, and transferrin (nutritional proteins). There were no correlations in concentration changes between these two groups of plasma proteins. The surviving group showed significant positive correlations between the nutritional plasma protein and intravenous amino acid dosage (prealbumin, p ≤ 0.001; transferrin, P ≤ 0.008; retinol-binding protein, p ≤ 0.001; and albumin, p ≤ 0.004) but no correlations with the acute-phase proteins.The nonsurviving patients showed significant intercorrelations between the acute-phase and nutritional proteins that were not seen in the surviving patients, and showed no relationship between intravenous amino acid dosage and the plasma levels of nutritional proteins. The data are consistent with increased obligatory catabolism of amino acids in the nonsurviving patient which based upon the amino acid behavior documented in the first paper in this series probably involves the branched-chain amino acids.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A patient is described who postoperatively developed a clinical syndrome characteristic of toxic shock syndrome following amputation of a previously injured finger. A small stitch abscess was identified which grew Staphylococcus aureus. The patient became ill within 12 hours of surgery, suggesting that a small inoculum of a toxic shock-producing strain of S. aureus can produce the clinical syndrome.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Four cases of suprascapular nerve injury following various types of trauma are reported. This nerve is subject to damage where it passes through the suprascapular notch. Initially, main complaints are vague shoulder area pain, weakness in shoulder abduction and external rotation, followed by atrophy of the shoulder girdle muscles innervated by the suprascapular nerve. Electromyography confirms the diagnosis. The literature was reviewed for possible mechanisms of the suprascapular nerve injury, which should not be confused with cervical radiculopathy, brachial plexopathy, or rotator cuff injury. Early active and passive range of motion exercises are recommended, to retard muscle atrophy and prevent secondary joint problems. If regeneration does not occur, surgical exploration should be considered.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID