ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The true incidence of thromboembolic complications following multiple trauma is unknown, and no method of prophylaxis has been shown to be both safe and effective in managing seriously injured patients. In this prospective study, 113 trauma patients were assigned on admission to receive either low-dose heparin (LDH), (5,000 U subcutaneously every 12 hours) or to wear sequential compression devices (SCDs) as prophylaxis against the development of deep venous thrombosis (DVT). Both groups of patients were serially studied with duplex venous ultrasound imaging to detect thrombus in the veins of the thigh. Ventilation-perfusion lung scans and pulmonary angiograms were performed when pulmonary embolism (PE) was suspected clinically. There were 12 patients who had thromboembolic complications, including 9 of 76 in the SCD group (12%) and 3 of 37 in the LDH group (8%). Five patients had DVT only, four had PE without detectable DVT, and three had both DVT and PE. None of the patients with PE died, and there were no major complications associated with either method of prophylaxis. Compared with the patients who did not develop DVT/PE, those with thromboembolic complications associated with either method of prophylaxis. Compared with the patients who did not develop DVT/PE, those with thromboembolic complications were older (49 ± 23 vs. 36 ± 17 years,p< 0.02), spent more hospital days immobilized (24 ± 15 vs. 10 ± 13 days,p< 0.001), received more transfusions (11 ± 12 vs. 3 ± 5 U,p< 0.001) and had clotting abnormalities on admission, as demonstrated by prolonged PTT values (39 ± 28 vs. 26 ± 5 seconds,p< 0.001). It appears that there is an identifiable subgroup of injured patients at highest risk for PE who warrant both prophylaix and close surveillance for DVT.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or cultur-proven mucormycosis. Nine patients were victims of blunt trauma, two patients had burns measuring < 50% TBSA. No patient was at increased risk because of underlying disease or immunosuppression prior to injury. All 11 patients had open wounds on admission. Four patients died of mucormycosis. All nonsurvivors had phycomycotic gangrenous cellulitis of the head, the trunk, or both. In contrast, survivors had involvement of only the extremities. Because of underlying disease, contaminating wounds, antibiotic use, or immunocompromise secondary to shock and sepsis, trauma patients are at risk of developing mucormycosis. To successfully treat mucormycosis, diagnosis must be prompt and accompanied by aggressive debridement and parenteral administration of amphotericin B.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Excessive tension in an abdominal incision line may lead to fascial necrosis and wound sepsis. We utilized two alternative approaches to wound closure in 13 patients with severe abdominal trauma (2 blunt, 11 penetrating) whose midline incisions could not be closed primarily without excessive tension at the initial operation because of massive visceral edema. In five patients synthetic mesh was used to bridge the fascial defect. Four patients survived the early postoperative period but had large open midline wounds that required one or more delayed procedures to close the wound or cover the visceral mass with skin graft. Two patients currently have large abdominal wall hernias. In the other eight patients the skin was reapproximated over the visceral mass utilizing towel clips at the initial operation. Six patients survived to be reexplored within 48–96 hours. Acute hemorrhage had stopped, the edema of the bowel and retroperitoneum had largely resolve, and the fascia could be closed primarily without excessive tension. All wounds went on to heal satisfactorily. When massive edema makes fascial closure at the initial operation difficult or impossible, closure of the skin over the visceral mass promotes resolution of the edema and often allows satisfactory primary closure within 48–96 hours. Synthetic mesh should be reserved for cases of abdominal wall tissue loss or dehiscece associated with wound sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Despite prophylactic antibiotic use in abdominal trauma patients, infection rates remain high. A previous study from our institution indicated that higher doses of prophylactic antibiotics in trauma patients could significantly reduce subsequent infection rates. To determine if this resulted from altered pharmacokinetic profiles, we performed individualized pharmacokinetic analysis of the prophylactic amikacin regimens given to 28 trauma patients undergoing laparotomy. Patients were prospectively randomized to receive a standard regimen of 11 mg/kg of amikacin every 12 hours or to have their regimens adjusted based upon pharmacokinetic analysis. Repeated pharmacokinetic analyses were performed daily for the three-day prophylactic regimen. There was a significant expansion in the apparent volume of distribution for amikacin that correlated with fluid resuscitation. This, along with increased elimination rates, helps to explain the failure to achieve adequate amikacin levels using standard regimens in trauma patients. Such underdosing may contribute to relatively high infection rates following major abdominal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Patients with traumatic asphyxia treated at a single institution during a 10-year period were studied to determine the incidence and sequelae of neurologic impairment associated with this entity. Traumatic asphyxia was identified in 14 patients from 4 to 73 years old. Each had sustained thoracic crush injuries from objects weighing more than 1,000 pounds. The mechanism of injury was crush by farm implement in six patients, entrapment beneath a vehicle in five, compression by a large hay bale in one, crush by a farm animal in one, and a ditch cave-in in one. Craniocervical cyanosis and subconjuctival hemorrhage were apparent in all patients. Associated chest wall and intrathoracic injuries were present in 11 (79%) patients. Neurologic abnormalities included loss of consciousness in eight patients, prolonged confusion in five, seizures in two, and pronounced visual disturbances in two. There were no deaths in this series and no long-term neurologic sequelae were evident. However, careful serial neurologic assessment should be performed in these patients and other causes of neurologic symptoms excluded.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The TRISS system is an important, widely used method for predicting survival in trauma patients. One significant shortcoming of TRISS is its inability to include intubated patients in survival analysis because a respiratory rate and a verbal response are not obtainable. This report describes one approach to this problem. Data from 994 patiens with blunt trauma were examined. Like TRISS, survival probability was calculated using a logistic regression model that included age and Injury Severity Score (ISS); however, the best motor response and systolic blood pressure were used in place of the Revised Trauma Score (RTS). With this model, the sensitivity, specificity, and misclassification rate were 57%, 98.9%, and 3.6%, respectively. For TRISS, the sensitivity, specificity, and misclassification rate are 58.8%, 99.3%, and 3.0%, respectively. Thus, our model has predictive performance comparable with TRISS. More importantly, it is applicable to intubated patients who are not pharmacologically paralyzed. Further investigation with larger data base is necessary.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Increased use of autotransfusion for traumatic hemorrhage may reduce amounts of banked blood needed for severe injuries. Autotransfusion is standard for traumatic hemothorax, but has been limited for abdominal injuries. This prospective study used microbiologic data from 152 patients with intestinal injuries. Where anticipated blood loss was < 1,000 mL, blood from the peritoneal cavity was cultured, washed, concentrated, and recultured before reinfusion. Infection rates were stratified using the Penetrating Abdominal Trauma Index (PATI). Fifty patients with PATI <20 who received banked blood (group I) (mean:1,800 mL) were compared with 20 patients (group II) who received autotransfused, potentially culture-positive blood (CPB) (mean:3,900 mL).Wound infection rates were identical in both groups (25%). No statistically significant increase was found in site-specific infection risk when severity of injury was stratified according to PATI. Bacteremias, pulmonary infections, and urinary infectionswere notcaused by bacteria cultured from autotransfused blood. We conclude that washed CPB may be autotransfused without significantly increased risk of infection in patients with severe abdominal injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The combination solution of 7.5% NaCl/6% dextran 70 (HSD) administered IV gives hemodynamic improvement in the treatment of hemorrhagic hypotension. Since earlier dextran solutions were reported to interfere with blood coagulation, the effects of HSD on the prothrombin time (PT), the activated partial thromboplastin time (APTT), platelet aggregation, and platelet concentration were studied. The HSD mixed with human plasma (1:5 and 1:10) slightly prolonged PT, but had no effect on the APTT, compared with saline controls. The HSD also decreased human platelet aggregation at the 1:5 dilution. In separate mixing studies, the hypertonic saline component of HSD was associated with the prolongation of PT and decreased platelet aggregation. The data from these studies indicate that at its proposed therapeutic dose, HSD is expected to have minimal effect on blood coagulation.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The published evaluation of methods for identifying preventable trauma deaths contains many unstudied confounding factors. To investigate the reliability of methods for identifying such preventable deaths, we compared three consensus systems using separate five-member general review panels assessing 20 non-central nervous system fatalities: panel A, independent judgments; panel B, discussion of all cases preceding individual judgements; and panel C, independent judgments followed by discussion and equivocal case reassignment. The Kappa concordance index was low for all methods (method A, 0.20; methods B and C, 0.40). Of the 11 deaths judged preventable by at least one panel, only death was judged preventable by all three panels. Consensus agreement (four of five assessors) was 20% for panel A, 45% for panel B, and 10% for panel C (difference between panels B and C,p

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID