ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Six hundred eighty‐five patients with major blunt thoracic injuries from 1968 through 1977 were retrospectively studied. This series was compared to a similar series from 1959 through 1964. Between 1964 and 1968 a vastly improved hospital was built, laboratory support improved, pressure‐controlled ventilators replaced by volume‐controlled ventilators and the trauma service was reorganized. The treatment regimen for flail chest injuries during the last decade evolved from the previous early tracheostomy and prolonged ventilator support to an avoidance of tracheostomy and brief ventilator support. The overall mortality in the present series was 20% compared to 35% for the 1959‐1964 series; however, improved mortality occurred only among patients with hemothorax who had one or more major concomitant extrathoracic injuries. The mortality for flail chest injuries did not improve (29.5 vs 35.0%). Mortality was unchanged for isolated flail chest injuries, isolated pneumothorax, isolated hemothorax, and for flail chest injuries, and pneumothorax in patients with concomitant major extrathoracic injuries. In both series deaths from isolated thoracic injuries were rare. It is evident that the continued high mortality for blunt thoracic trauma principally relates to concomitant extrathoracic injuries and that recent treatment innovations have not reduced the mortality of flail chest injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The trauma victim with a severe closed head injury, who requires general anesthesia for emergency repair of concomitant exigent major injuries, poses a clinical dilemma. During general anesthesia and during the immediate postoperative period, the status of the patient's central nervous system cannot be clinically monitored, and emergency cerebral arteriograms and/or CAT scans are not easily obtained. Under these circumstances, delays in the diagnosis of intracranial blood accumulations frequently occur, and occult cerebral edema often goes untreated. In an attempt to avoid these management problems, we have employed intraoperative intracranial pressure (ICP) monitoring in such patients, using a subarachnoid screw. Following placement of this screw, several clinical courses may occur: 1) The patient maintains a normal pressure; thus a significant mass lesion and/or cerebral edema requiring decompression is unlikely. 2) The patient's ICP is elevated but controlled by medical management. 3) The patient's ICP cannot be controlled below 20 to 25 mm Hg using medical management, and exploratory burr holes are made. 4) If intracranial blood is encountered during placement of the ICP monitor, immediate exploratory craniotomy is indicated.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Twenty patients with burn injuries involving 45% or more total body surface area were randomly allocated to receive either fresh‐frozen plasma (plasma), 200 ml/m2/d (11 patients), or an approximately equal amount of plasma protein derivative (Plasmanate©) (nine patients) during the first 45 days postburn. To study the potential effects of these two adjunctive therapies on host resistance to infection, measurements were made twice weekly of the antibacterial function of neutrophils, the opsonic index (ability to opsonize alternative pathway dependentE. coli075), C3(B), IgG, properdin, factor B, total protein, and albumin. The average size of burn in the plasma group was 61.5% total and 42% 3° compared with 61% total and 46% 3° in the Plasmanate group. Ten and 18 episodes of bacteremia occurred in the plasma and Plasmanate groups, respectively. Analysis of the results indicates only slightly better support of host resistance when plasma is administered, but this is counterbalanced by the increased risk of viral hepatitis.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The effect of catecholamines and adrenergic receptor blocking drugs on mortality and body temperature was studied in mice subjected to burn, tourniquet, and endotoxin shock at an environmental temperature of 25° C. Epinephrine and norepinephrine (0.5 mg/kg) injected intraperitoneally postburn increased shock mortality significantly (p< 0.05); pretreatment with these catecholamines had no effect. Pretreatment of burn‐ and tourniquet‐traumatized mice with propranolol (25 mg/kg) significantly decreased shock mortality, while pretreatment with dibenamine (25 mg/kg) significantly lowered early mortality after endotoxin. None of the catecholamines or their blocking drugs significantly prevented the characteristic immediate fall in core temperature after the three types of shock. At 6 days postburn, however, a combination of propranolol and dibenamine caused a marked fall in core temperature (p< 0.05). These results indicate that &bgr;‐catecholamine agonists could play an important role in acute burn mortality and that both &agr;‐ and &bgr;‐catecholamine agonists could significantly influence body temperature regulation and metabolic rate during the late postburn period.

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

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Cardiac injuries occur infrequently in children. Although the mechanisms of injury are not unique to the pediatric age group, the frequency of the various injuries is quite different. This unusual nature dictates an enhanced awareness for proper management. Twenty cases were recognized in a 16‐year retrospective review. There were six children with perforations from cardiac catheterizations, ten children with penetrating injuries, and four children with blunt injuries. Two of the children with blunt injuries presented as myocardial contusion and one child survived blunt rupture of the right atrium. Only one death occurred in the series—a newborn baby who died from an unrecognized cardiac tamponade secondary to perforation of the right ventricle during catheterization. The diagnosis and special techniques for management of injuries due to catheter perforation and blunt injuries of the heart in infants and children are discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A 20‐year retrospective evaluation of vascular trauma in infants and children was undertaken. The study included 53 cases of blunt and penetrating vascular injuries in pediatric patients. There were 36 males and 17 females ranging in age from 24 days to 14 years (average, 10 years). The most frequently encountered sites of arterial trauma were the brachial or superficial femoral artery, and of venous trauma the inferior vena cava. Any patient presenting to the Emergency Center with an injury in proximity to a major vessel, hematoma formation, audible bruit, or palpable thrill underwent prompt arteriography or immediate operative exploration of the injury site. All patients in the series were managed operatively. There were 41 major arterial and 32 major venous injuries. No patient required a major amputation. Most injuries were repaired by primary closure or segmental resection and end‐to‐end anastomosis; interposition vein grafts and substitute conduits were used in four patients with more extensive injuries. A 13% operative mortality was encountered: the most frequent cause of death was intraoperative exsanguinating hemorrhage. The triad for successful management of vascular trauma in pediatric patients is: 1) a high index of suspicion, 2) performance of aggressive diagnostic studies when indicated, and 3) prompt surgical intervention.

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