摘要:

The diagnostic criteria of clinical fat embolism syndrome are most important. Petechial rush, positive chest X-ray films, low arterial oxygen content, and cerebral involvement are major features. Three different grades of fat embolism can be distinguished. The development of the first grade cannot be prevented. By early internal fixation of long-bone fractures in patients with multiple injuries it may be possible in most cases to prevent the development of the third grade, the severe clinical fat embolism syndrome. Thus specific treatment because of fat embolism was indicated in only three cases in this series of 211 patients with broken long bones and multiple injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Prophylactic mechanical ventilation with PEEP of patients with severe injuries prevents or attenuates the clinical manifestations of ARDS. Also, operative stabilization of all major fractures appears to be beneficial in reducing the incidence of ARDS. Primary external or internal fixation of all unstable long-bone fractures combined with prophylactic ventilation is safe and well tolerated, and allows for optimal nursing of the patient. In a group of 58 severely injured patients, treated accordingly to these principles, late death from remote organ failure due to sepsis—which is the main cause of death in multitrauma patients treated with delayed osteosynthesis or conservative fracture treatment—did not occur. Prophylactic mechanical ventilation with PEEP resulted in a significantly lower incidence of ARDS.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Many studies have reported similar weight gains and nitrogen balance in groups of well-nourished animals fed either orally or intravenously, but none have investigated the effects on malnourished animals. After protein depleting for 14 days, rats were refed with a D25–4.25% amino acid solution orally ad lib, by gastrostomy, or intravenously.IV animals gained more weight with greater body fat formation than either enteral group but had lower intestinal mass and nitrogen. Route of administration influenced substrate utilization in malnourished animals fed identical diets. We conclude that weight gain cannot be used as a comparative indicator of nitrogen retention between malnourished animals fed enterally and those fed intravenously.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Parameters thought to reflect nutritional status were assessed in 25 critically ill postoperative patients who had been acutely injured. Results were compared with those from a group of 28 critically ill postoperative patients who had not sustained trauma. The anthropometric measures were significantly better preserved in the previously healthy and presumably well-nourished trauma patients, but striking abnormalities were observed in both groups in albumin and transferrin levels, in the lymphocyte count, and in skin test reactivity. The latter findings suggest the influence of non-nutritional factors at least in the acutely injured patient.Anergy, although frequently observed in both groups of patients, was not predictive of mortality nor did the 44 surviving patients differ significantly in any of the other measured parameters from the nine patients who died.We conclude that, at present, the need for nutrition therapy for the acutely injured patient is best determined on traditional clinical grounds.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In a prospective randomized controlled trial polyurethane casts and traditional plaster-of-Paris braces were compared in 46 cases of Colles' fractures of the forearm. Secondary fracture dislocation, subjective inconveniences, and the need for secondary adjustment of the cast were recorded. No significant difference was observed in the two groups. In comparison with plaster the synthetic bandage is lighter, water repellent, and hardens faster, and as far as circular bandages are concerned, they have zippers. It is concluded that polyurethane braces are a good supplement to plaster-of-Paris bandage in such fractures and recommended in selected cases.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

One hundred thirty-four cases of occipital skull fracture seen over the past 15 years at the Medical Center Hospital of Vermont have been analyzed with respect to their clinical course and neurologic outcome. Among the cases reviewed, one third of patients had an uncomplicated course, 24% recovered with mild neurologic findings (such as a cranial nerve palsy), and 13% died as a result of neurologic insult. This high morbidity results from combinations of traumatic subarachnoid hemorrhage, coup and contrecoup brain lesions, and injury at the skull base. Posterior fossa hematoma, cerebellar contusion, parietal and occipital lobe injury, and cranial nerve injuries associated with this lesion are discussed in detail. CAT scanning is now part of our diagnostic routine in patients with occipital fracture in coma grades 1–5 (Grady scale).

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

External cardiac compression (ECC) was originally developed for patients with nontraumatic cardiac conditions, but it is now used for a wide variety of emergency conditions. As an integral part of cardiopulmonary resuscitation (CPR), ECC coupled with forced pulmonary ventilation may NOT be applicable to cases of cardiac arrest following penetrating and blunt thoracic and abdominal trauma. Review of 100 patients with penetrating or blunt truncal trauma who received CPR and ECC more than 3 minutes prehospital revealed NO survivors despite continued aggressive resuscitative efforts in 49 of the patients upon arrival at a trauma center. Major cardiovascular disruption was found at thoracotomy or autopsy in all patients. In another 12 patients receiving forced ventilation and prehospital ECC, air embolism to the coronary arteries was the cause of death. CPR by paramedics, physicians, nurses, or lay persons does not appear to be of value in patients who have sustained cardiac arrest from truncal trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The purpose of this study was to explore the possibility of extrinsic coronary artery compression following nonpenetrating cardiac trauma. Direct impact on the anterior surface of the heart was produced by a blunt air-pressurized impactor in 34 open-chest anesthetized dogs. Sections from the left anterior descending coronary artery and the left circumflex coronary artery were obtained for microscopic examination from each of the 17 dogs that survived the duration of observation (90 minutes). Gross examination of the external surface of the heart showed contusions over the anterior surface and prominent extravascular hemorrhage that followed the course of the left anterior descending coronary artery, whereas the posterior surface, including the circumflex coronary artery, showed no contusion or extravascular bleeding. In most instances, light microscopy showed narrowing of the lumen of the left anterior descending coronary artery with concave deformation resulting from compression by blood around the vessel. The cross-sections of the circumflex coronary artery, although sometimes oblong, showed no concave deformation. These observations suggest that extrinsic compression of the coronary artery may cause coronary narrowing following nonpenetrating cardiac trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study was originated in recognition that little data have been accumulated in the literature regarding concentrations of gentamicin in various infected tissues. The study was undertaken to determine if systemically administered gentamicin penetrates burn wound eschar and to determine if there is a relationship between gentamicin serum levels attained and concentration of gentamicin reaching the eschar. Five hospitalized adult patients requiring parenteral gentamicin for sepsis secondary to third-degree burns were studied prospectively. For the purpose of determining the amount of gentamicin reaching the eschar, biopsy of the burn wound eschar was performed on each patient. Venous blood samples were also obtained to examine the relationship of serial serum samples to eschar levels. Calculated pharmacokinetic parameters include elimination rate constants, apparent volume of distribution, β, and gentamicin half-life. The data indicate that systemically administered gentamicin does penetrate burn eschar in measurable quantities. Deeper layers of eschar tissue contained significantly greater quantities of gentamicin. Analysis of variance resulted in statistically significant (p < 0.05) rise in eschar concentration with time. A positive correlation between the peak serum gentamicin concentration and the concentration of gentamicin reaching the burn tissue was found. The quantity of gentamicin attained was sufficient to prevent proliferation of organisms cultured from the eschar of patients. Accumulation of gentamicin in the eschar occurred in every patient studied. This study suggests the eradication of organisms in eschar samples is due to the achievable concentration of gentamicin at this site.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID