摘要:

Over a 54-month period 6,142 patients were consecutively admitted to our Level I trauma center. Ninety-two blunt trauma patients required massive transfusion (MT) of 20 or more units of packed red blood cells (range, 20–126). Eighty-two per cent of all transfused blood was given within 24 hours of admission. Forty-eight patients (52%) were long-term survivors. Twenty-six patients died (28%) within 24 hours and 21 of these exsanguinated. Eighteen patients died > 24 hours: nine (50%) died from multiple organ failure, and nine (50%) died from severe closed head injury (CHI). Clinical predictors of increased mortality were: shock on admission, closed head injury, and age.Forty-three survivors were followed for a mean of 2.5 years (range, 1–5 years). No patient died during followup. All patients were home at 1 year; only four patients required continued medical assistance. Thirty-two patients (74%) returned to work. We conclude that: 1) blunt and penetrating trauma patients receiving MT have similar survival rates of 50%; 2) shock, closed head injury, and age predict increased mortality but do not preclude survival: 3) long-term outcome in blunt patients requiring MT is excellent. Post-discharge death is rare and 3/4 of the survivors return to work, justifying the high cost of acute care.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hypertonic (7.5%) saline (HS) is advocated for resuscitation of injured and burned patients. Recent animal studies indicate that HS increases bleeding during uncontrolled hemorrhage, although the mechanisms for this are unclear. To investigate potential anticoagulant effects of HS (without dextran), normal human plasma was serially diluted with either HS or normal (0.9%) saline (NS). Prothrombin times (PT), activated partial thromboplastin times (APTT), and platelet aggregation studies were performed. Significant (p< 0.05) deteriorations in clotting tests and platelet aggregation developed when 10% or more of normal plasma was replaced by HS, whereas there was no effect from similar NS dilutions. Strong correlations were observed between clotting test changes and sodium concentrations (R2> 0.80,p< 0.0001). Thus, HS exhibits anticoagulant activity, but not at the usual small volumes necessary to produce hemodynamic improvement. Nevertheless, the anticoagulant effect may be more pronounced with ongoing clotting factor losses or with the addition of dextran.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent advances have radically changed the management of facial fractures. CT scanning, extensive exposure, and rigid plate fixation in the setting of the trauma center have permitted early operation with improved results. A subset of patients with facial fractures will also have intracranial injuries (ICI). We sought to identify parameters associated with an increased risk for ICI. We also sought to examine the safety and limits of early craniofacial repair in patients with intracranial injuries.Of 114 mid-face fractures treated over a 1-year period. 43 (38%) had a concomitant ICI. The majority, 36(84%), were from motor vehicle accidents (MVA). Frontal sinus and orbitoethmoid fractures were at the highest risk for ICI, although orbitozygomatic fractures caused by MVAs also had a surprisingly high incidence of ICI. Our results show that early craniofacial repair can be performed safety with appropriate general surgical and neurosugical support.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The reliability of ultrasonographic detection (US) of hemoperitoneum in blunt abdominal trauma was evaluated in a prospective study of 72 patients. Independent of the examiner, sensitivity, specificity, and accuracy were, respectively, 86.7%, 100%, and 97.2%. Laparotomy was indicated in 76.9% of US hemoperitoneum-positive cases. No negative laparotomies were performed in this study group. If hemoperitoneum is revealed in US and vital signs are unstable, we think laparotomy is indicated. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. US might take over a great part of the role of diagnostic peritoneal lavage.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Multipiece tire rims can explode during tire change, causing severe injury. Although more than 450 such accidents, with at least 80 deaths, have been recorded by the National Highway Traffic Safety Administration (NHTSA). we found no reports in the surgical literature on such injuries in the United States.This report describes experience with seven patients who sustained injuries in explosions of multipiece tire rims. All victims suffered massive maxillofacial trauma with associated ocular, cranial, intracranial, and extremity injuries. Two patients died, both because of intracerebral hemorrhage. One patient suffered serious long-term disability. All survivors required extensive reconstructive surgery.The design of the multipiece tire rim is inherently hazardous. Since many accidents of this type are not reported to the NHTSA, the incidence of such injuries may be significantly higher. An alternative, nonhazardous tire rim is available. Design modifications or a law restricting use of multipiece tire rims would prevent many accidents.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thirty-seven consecutive patients with unstable pelvic fractures were divided into two groups: Group 1 (July 1981 to December 1984;n= 18), when early fixation was not routinely used, and Group 2 (January 1985 to March 1988;n= 19), when early fixation was performed unless contraindicated.Hospital stay decreased by 37.8% in Group 2 (p= 0.04). Of Group 1 patients, 60% were disabled for at least 6 months versus 15.7% in Group 2 (p= 0.001), and 45% were discharged to a rehabilitation facility versus 26.4% in Group 2. Group 1 had more complications, 1.3 per patient, versus 1.0. Patients in Group 2 (undergoing early fixation) required 27.2% fewer units of blood than those in Group 1 in whom fracture surgery was delayed. Survival was better in Group 2, 100% versus 83.3% (p= 0.06). Early pelvic fracture fixation reduces hospital stay, long-term disability, and may result in fewer complications, decreased blood loss, and better survival.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We sought evidence of oxidant-induced biological membrane damage in 43 resuscitated blunt trauma patients (average ISS, 36.9) within 2–6 hours of injury and before anaesthesia and surgery. The plasma levels of the lipid peroxidation products (conjugated dienes, CDs A 233nm) and malondialdehyde (MDA, nMol/ml) and the oxidant-inducing effect of the trauma plasma on normal FMLP-stimulated neutrophils were compared to those of control subjects. No differences were observed in the plasma levels of MDA (1.73 ± 2.15 vs. 1.45 ± 0.70 nMol/ml) and CDs (2.07 ± 2.16 vs. 1.28 ± 0.60 A 233nm). or on stimulated neutrophil superoxide production (26.4 ± 6.9 vs. 29.0 ± 6.2 nMol O2∼/2 x 106PMNs). These observations persisted when the patients were analyzed based on injury severity, the presence of long bone fractures, and the class of shock at presentation. We conclude that there is no evidence of oxidant-induced membrane damage manifested by increased plasma levels of CDs or MDA within 2 to 6 hours of blunt injury.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Heat loss leading to hypothermia is common during surgery, particularly when a body cavity is exposed. To determine the principal site of heat loss we used heat flux transducers to measure heat loss from the skin and the exposed abdominal cavity of seven pigs. Heat loss from the skin was 74 ± 15 W/m2, and from the abdominal cavity, 350 ± 122 W/m2(p< 0.002; ratio = 1:4.7). The area of the skin was 0.52 ± 0.06 m2, and of the abdominal cavity, 0.04 ± 0.006 m2(ratio = 13.6:1). For every 13.6 watts lost from the skin, 4.7 watts were lost from the abdominal cavity; i.e., skin heat loss accounted for 74% of total heat loss. Therefore adequate insulation would reduce the incidence of hypothermia. Evaporation accounted for the largest heat loss from the abdominal cavity. Evaporative losses could be minimised by enclosing the bowel in a plastic bag.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study profiles the practices, experience, and viewpoints of general surgeons treating trauma patients throughout a state. A mail survey of the American College of Surgeons State Chapter membership was conducted. Response rate of general surgeons was 65%. Typically, the trauma surgeon is between 30 and 50 years old, having received formal trauma experience through residency training only. Thirty-nine per cent report current ATLS certification. Practices are most commonly based at a community hospital in an urban setting. Half of surgeons treating trauma operate at more than one hospital and nearly a third take call at more than one hospital simultaneously. Eighty-seven per cent of respondents reported trauma patients comprise less than one quarter of their practice. Most (68%) admitted fewer than 25 trauma patients to their service in the year before the survey and 78% reported performing less than ten trauma laparotomies in the prior year. Fifty-eight per cent disagree that every general surgeon should routinely manage major trauma and 83% feel that traumatology entails a specific body of knowledge and expertise. Of the various components of trauma care, the role of the surgeon in trauma prevention and administrative duties was ranked as least important.The areas of surgeon availability, uniformity of basic experience and adequate maintenance of skills need further analysis.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A longitudinal, prospectively gathered data base of spine trauma has been developed. A review of 508 consecutive hospital admissions identified the presence of associated injuries in 240 (47%) individuals, most frequently involving head (26%), chest (24%), or long bones (23%). Twenty-two per cent had one associated injury, 15% had two, and 10% had three or more. Most spine fractures involved the lower cervical (29%) or thoracolumbar junction (21%). Comparisons of presence or absence of associated injuries and spine fracture level showed significant differences (p< 0.001). Eighty-two per cent of thoracic fractures and 72% of lumbar fractures had associated injuries compared to 28% of lower cervical spine fractures. While there was no significant relationship between type of associated injury and spine fracture level, those with associated injuries were less likely to have a neural deficit (p< 0.05). After hospital admission, there were seven deaths.Early assessment and transport of spine trauma victims must be carried out with appropriate management of associated injuries. Conversely, multiple trauma victims must be handled with due regard for a possible spine fracture. The value of spinal units with specially trained personnel is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID