摘要:

The relative performance of whole blood and saline, a balanced salt-albumin solution, and Fluosol-43 were compared in an experimental animal model of combined hypoxia and hypotension. The test fluids were evaluated in terms of their respective ability to restore mean arterial pressure and provide adequate oxygen to restore and maintain a normal brain cytochrome a,a3redox state, restore and sustain normal cerebral cortical ATP and creatine phosphate concentrations (CP), and return cerebral cortical lactate concentrations to normal after the hypoxic-hypotensive period. With regard to ATP, CP, lactate, and cytochrome a,a3, all three test fluids performed equally well inasmuch as there were no significant differences between groups. None of the test regimens resulted in normal ATP concentration post-hypoxic hypotension. Although CP concentrations were lower than baseline after resuscitation, the difference was not statistically significant. Fluosol-43 resuscitation resulted in a significantly higher (p< 0.05) mean arterial pressure by 120 minutes post-resuscitation. It was concluded that Fluosol-43 is an acceptable resuscitative fluid, most beneficial at extremely low hematocrits, but that selection of Fluosol-43 over balanced salt-albumin could not be supported when post-resuscitation hematocrits were in the 20 to 25% range.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Percutaneous transtracheal ventilation can be a lifesaving procedure when endotracheal intubation is not possible, but an understanding of the technique and necessary instruments is essential. This study, performed on adult sheep, defined the limited circumstances under which a 15-gauge needle, connected to oxygen at 50 pounds per square inch (psi), can provide an emergency transtracheal airway. There are situations, such as complete airway obstruction, when this combination is contraindicated. In addition, transtracheal ventilation might have to be performed using simpler equipment, such as a self-inflating resuscitation bag (AMBU-type) or with no equipment other than the transtracheal airway. A 3.0-mm I.D. cannula provided an adequate transtracheal airway under all circumstances examined. A 3.5-mm cannula is commercially available and physicians who deal with airway problems should be familiar with its use.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Management of the pediatric patient sustaining a traumatic injury is influenced by patient size, surface area to body mass ratio, thermoregulation, and fluid requirements. A predetermined and systematic approach to the injured child guarantees recognition of life-threatening injuries and provides a method for rapid stabilization. The algorithm is divided into two distinct phases: life support and post-stabilization. The unique aspects of care of the injured child are highlighted to emphasize the significant differences in resuscitation and diagnosis from that of the adult patient.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Hip fractures in patients with Parkinson's syndrome present a continuing challenge to orthopaedic surgeons. Sixty-two consecutive such patients have been reviewed. With or without operation, there was very high rate of mortality (31%) and complications. However, the functional results, the ability to walk, progression of the disability, and the quality of life were significantly better after operation. The results suggest that operation is the preferable solution for these patients. They require, however, much more particular care than other patients with hip fractures. This includes adequate adjusted antiparkinson medication, appropriate anesthesia with special attention to adequate ventilation and postoperative analgesia, more intensive respiratory and functional physiotherapy, very meticulous nursing care, and a relatively extended period of preventive antibiotics.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Mortality in burned patients is related to the size and depth of the burn. However, the effects of subsequent physiologic subsystem failure on mortality have not been determined. One hundred sixty-eight patients with second- and third-degree burns involving 40% or greater body surface area were analyzed to determine the relationship of subsystem failure to mortality. Cardiovascular subsystem failure was defined as the need for catecholamines for blood pressure support, pulmonary failure defined as the requirement of mechanical ventilatory assistance, renal subsystem failure defined as the need for hemodialysis, and immunologic subsystem failure defined as the presence of sepsis (fever, tachycardia, hypotension, oliguria, disorientation) and/or bactcremia. The mean age of the group was 40 ± 17 years, with 50 (30%) females and 188 (70%) males. The mean BSA burn was 59% ± 15% with an overall mortality of 58% (97 patients). Sixty-seven (40%) patients developed cardiac subsystem failure, with 100% mortality. Eighty-nine (53%) patients developed pulmonary subsystem failure, with 92% mortality. Renal subsystem failure was noted in 14 (8%) patients, with 100% mortality, and immunologic subsystem failure occurred in 96 (57%) patients, with 73% mortality. The 81 patients with multiple subsystem failure (≥2) had a significantly higher mortality (98%) than those with zero or one subsystem failure (21%) (p< 0.001). This study shows patients who develop physiologic subsystem failure following a major burn injury have an extremely high mortality rate and that multiple subsystem failure is even more devastating.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Patients, after major thermal injury, often develop multiple in vitro immunologic abnormalities. The etiology of these immune defects is unknown, although there is evidence suggesting that these defects may be the results of circulating suppressor substance(s). To evaluate the role of the local injury in the development of immune incompetence the biologic effect of blister fluid on control lymphocyte mitogenic response to PHA was studied. Blister fluid from 35 patients, mean burn size 29% (range, 1–85% TBSA) was added to a standard lymphocyte blastogenic assay, using various concentrations of PHA (from 0.5 μg to 40 μg per well). Eight of these 35 patients (23%) had blister fluid which suppressed the control lymphocyte blastogenic response greater than 50%. Two patients with suppressive blister fluids also had suppressive serum. In contrast, only two of the nine patients whose blister fluid was not suppressive had suppressive serum. This suppressive activity was not related to bacterial contamination nor to the presence of detectable levels of endotoxin.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This study was carried out to investigate the relative time courses of the presence of a reticuloendothelial (RE) depressing substance and reticuloendothelial system (RES) phagocytic function following thermal injury in animals: additionally, RE depressing activity was determined in burned patients. Following thermal injury in dogs, RE depressing activity was first detected 2 hr after injury and persisted for 12 hr. RE depressing activity was present in the circulation of burned rats at 3 and 24 hr but not 48 hr after injury. RES phagocytic function was also depressed at 3 and 24 hr but not at 48 hr after thermal injury in rats, showing that there was a close association between the presence of RE depressing activity and RES depression. Injection of RE depressing substance into normal animals depressed the RES for less than 60 min. Five of six burned patients studied within 5 days after injury had detectable RE depressing activity in their circulation. These findings further support the concept that a RE depressing substance contributes to the depression of RES phagocytic function and impairment of host defense following thermal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effect of GIK (glucose-insulin-potassium) therapy, as an adjunctive treatment, on cardiac function and urine excretion in the early phase of extensive burn injury was investigated. In early postburn patients, within 48 hours after injury, the GIK therapy resulted in a prominent and continued elevation of cardiac index (CI) (p< 0.05) due to elevated stroke volume index (SVI) (p< 0.05) and left ventricular stroke work index (LVSWI) (p< 0.05), and decreased total peripheral resistance (TPR) (p< 0.05), whereas it produced only a transient increase of CI in the control patients and no noticeable changes in the septic patients. A comparative analysis of these parameters and blood volume in GIK-administered patients and 50% glucose-infused patients revealed the elevated left ventricular performance to be due to enhanced contractility of the heart. The GIK therapy also produced a remarkable and continued increase of urine volume (p< 0.01), at least in part attributable to the elevated CI, whereas in the control and septic patients it produced only a transient increase of urine volume, merely reflecting the hyperosmolar property of the GIK solution.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

From 1969 to 1981 blunt renal injuries were recorded in 219 children up to the age of 16 years. All children with renal laceration, rupture, or pedicle injury had associated injuries, and 76% of them had a laparotomy for intraabdominal injury. Conservative management of five severe renal injuries in children resulted in 40% having a delayed renal operation and a total renal loss in 40%. A review of the published series of conservative management of severe renal injuries in children shows a renal surgery rate of 17 to 70%, a renal loss rate of 5 to 40%, and a significant complication/renal surgery rate of 32 to 80%. If conservative management of severe renal injuries in the multiple-injured child is used then up to 70% will require a second operation for the renal injury in a critically ill child recovering from the first operation. The nephrectomy rate with immediate surgical management of 16 severe renal injuries was 11% with nine renal lacerations, 100% with four renal ruptures, and 33% with three pedicle injuries. Two (67%) of the three pedicle injuries had immediate vascular repair with salvage of the kidney. There was increased renal salvage, reduced morbidity, and no need for a second exploration with immediate surgical management of severe reual injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Successful management of patients with renal trauma requires definition of the extent of injury and knowledge of the indications for exploration. The 185 consecutive cases of renal trauma requiring surgery at Parkland Memorial Hospital between 1976 and 1980 are reviewed. Injury was due to penetrating trauma in 85% of cases, and blunt trauma in 15%. The most common associated injuries following penetrating trauma were to liver, small bowel, stomach, and colon; splenic injury was more common in blunt trauma. Renal pedicle injuries in 26 patients (14%) had an operative mortality of 12% compared to 5.4% for the entire group. Renal salvage occurred in 85, 70, and 64% of stab wounds, gunshots, and blunt trauma, respectively. The importance of prompt and accurate radiographic assessment of injury with aggressive use of renal arteriography is stressed.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID