摘要:

Myocardial dysfunction may result from severe trauma. Therefore, left (LV) and right ventricular (RV) function were prospectively assessed by ECG-gated blood pool radionuclide (RN) angiography in 25 consecutive patients who had sustained severe trauma including blunt chest injuries. Focal abnormalities of RV and LV wall motion were defined in 17 patients; 12, RV; two, LV; and three, biventricular. In two patients traumatic tricuspid insufficiency was also demonstrated, and subsequently verified by contrast angiography. Other means to detect myocardial contusion (enzymatic, electrocardiographic, and Tc-99m pyrophosphate scintigraphy) proved to be insensitive when compared to RN angiography. Two of the five deaths in the group were attributed to refractory arrhythmias. Surgical or post-mortem evidence of traumatic myocardial injury was obtained in five instances when RN angiography indicated contusion. Of the 13 patients available for followup examinations, 11 showed complete or partial resolution of the abnormality and two were unchanged.Comprehensive cardiopulmonary monitoring revealed an inverse relationship between right ventricular ejection fraction (RVEF) and pulmonary vascular resistance (PVR) (R2= 0.42;p< 0.01) and between the PVR and left ventricular ejection fraction (LVEF) (R2= 0.48;p< 0.01) and left ventricular end-diastolic volume (LVEDV) (R2= 0.69;p< 0.01). Further, as right ventricular end-diastolic volume (RVEDV) was increased in trauma, left ventricular function and compliance were reduced.In blunt chest trauma RV contusion occurs more frequently than previously recognized and positive RN angiography constitutes prima facie evidence of direct myocardial injury. Further, LV function remains preload dependent, but may be depressed by elevated PVR impeding the blood flow from RV to LV and/or decreases in LV compliance.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The anemia of thermal injury is characterized by a decreased RBC half-life and abnormal RBC morphology (predominantly echinocytes). These changes are reversible in crossover studies with normal recipients, suggesting an extrinsic mechanism unrelated to initial heat or mechanical damage. Since alterations in plasma lipids, which are freely exchangeable with red cell lipids, produce similar changes, plasma and erythrocyte membrane lipid composition in 30 patients (mean 60% TBSA) was determined and related to RBC morphology in vivo and in vitro. Total cholesterol (TC) and phospholipids (PL) were decreased in plasma and plasma lipoproteins (LP) but remained normal in red blood cell membranes. The deficit in TC and LP cholesterol resulted from decreased cholesterol esters. Plasma phospholipids contained increased phosphatidylcholine (PC) and low lysophosphatidylcholine (LPC) and sphingomyelin levels. The essential fatty acid (EFA) composition of total plasma lipids rapidly decreased, with a more gradual decrease in EFA in red cell lipids. The ratio of free fatty acids to albumin in the plasma was greatly increased throughout and may have a primary role in the abnormal erythhrocyte morphology and decreased half-life in burned patients.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The presence of circulating factors in the plasma of shocked dogs which would be capable of causing lung lesions when infused into normotensive dogs was demonstrated by light and electron microscopy. Light microscopy only identified significant differences in atelectasis, vascular congestion, and interstitial edema in the shock and shock-plasma recipient animals. On electron microscopy, interstitial edema and disruption of collagen bundles were consistently found in shocked dogs and in dogs that had received shocked plasma. There was a consistent increase in pulmonary interstitial sodium in both shock and shock-plasma recipient groups. It is concluded that a plasma factor present in the serum of shocked dogs may be transferred to other dogs and cause histopathologic changes seen in the lungs of shocked animals.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Eleven people were killed in a railway accident. Four of them died of severe blunt injury, three of moderate injuries combined with traumatic asphyxia and suffocation. Four of the victims were only slightly injured but showed distinct signs of traumatic asphyxia. An extensive pulmonary microembolism syndrome consisting of bone-marrow and fat embolism was found in these cases. Comparing the morphologic findings after suffocation by thoracic compression and traumatic asphyxia the authors attribute independent pathophysiologic significance to traumatic asphyxia. The importance of autopsies and histologic examinations in railway accidents is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

An autopsy method for evaluating trauma care is described, which records patient age, time interval from hospital arrival to death, whether operation was performed, and cause of death. The technique is inexpensive, can be performed rapidly by a small number of examiners, and utilizes data sources that are a matter of public record. The method has proven to be valuable in evaluating trauma care in Orange County and we feel it may have widespread applicability.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A 3-year experience with diaphragmatic disruption secondary to blunt trauma was reviewed. Seventy-five per cent of the disruptions were on the left side and the incidence of associated intra-abdominal and thoracic injuries was 100%. Disruption occurred in two distinct anatomic positions: 1) through the central tendon; 2) at the lateral costal insertion. Diagnosis was usually made by plain X-ray films of the chest, occasionally with the aid of fluoroscopy. Difficulty was encountered making the diagnosis preoperatively, especially when there was significant hemothorax and/or pulmonary contusion. Angiography was diagnostic in three cases. Careful examination of the diaphragm in all blunt abdominal cases is essential to avoid delay in diagnosis. In the patients with an associated ruptured hollow viscus there was high incidence of empyema leading to severe morbidity. In such cases concomitant thoracotomy at the time of definitive therapy should be considered. The mortality of this injury is primarily related to the incidence of associated injuries and pre-existing, nontraumatic disease. Diaphragmatic disruption rarely occurs alone in blunt trauma. Laparotomy is required for control of hemorrhage in most cases.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Cardiac trauma can be experimentally produced by blunt impulsive impact over the cardiac apex in the anesthetized canine. A gradation of myocardial injury, including transient arrhythmia, contusion, and lethal ventricular fibrillation, can be produced by varying the power of the charge in a modified captive bolt pistol. Ballistics experiments were conducted to quantify the velocity, energy, and trajectory of impacts produced by the modified captive bolt pistol using various charges.Correlation of the impact data with the previously reported levels of trauma indicates that a 24 m/s impact with 178 joules of available energy results in lethal ventricular fibrillation with extensive myocardial contusion. Blunt impact at 17 m/s with 102 joules causes serious myocardial injury and at 13 m/s with 67 joules causes minor transient arrhythmia.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In a series of 41 subtrochanteric femoral fractures and 12 supracondylar fractures of the femur treated with internal fixation utilizing side plates, the number of cortices used to secure the shaft fragment to the plate varied from three to 24. Experimental evidence suggests that four screws, or eight cortices, provide a good margin of safety. This study provides a clinical confirmation of this experimental finding. Shaft fragments should be held with screws transfixing eight to ten cortices. Twenty-seven of the 53 fractures (51% of the fractures in this series) had fixation of the shaft fragment with more than ten cortices. These patients thus had excessive dissection, greater blood loss, the implantation of larger hardware, and a greater risk of infection than was necessary.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Ninety consecutive nonpathologic traumatic fractures of the shaft of the femur in pediatric patients above 3 years of age were seen from 1972 to 1976. Patients with less than 6 months' followup, patients with concomitant trauma to the same extremity, and one patient with decerebrate rigidity were excluded from the study. This left for evaluation 60 fractures in 59 patients, all treated by 90–90 femoral skeletal traction. The average length of followup was 17.4 months. There were no pin tract infections. All patients had a full range of active and passive motion of the involved extremity. All of the children were engaged in the normal activities of their age group. Final femoral lengths by teleroentgenograms in patients followed over 1 year could not be correlated with the original fracture position whether distracted, end-on, or overriding. It is recommended that no more than 5 mm of overriding be accepted when using this method of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Acute trauma victims are at high risk for gastric aspiration during urgent anesthesia. The morbidity of this complication is well known and is directly related to the acidity of the gastric contents. A pH less than 2.5 is associated with a marked increase in pulmonary sequelae. Cimetidine has been effective in the treatment of peptic ulcer disease because of its ability to elevate gastric pH. This was a prospective randomized study of administering a single dose of cimetidine (300 mg IV) to trauma patients in the Emergency Department. Fifty patients were studied and 39 (78%) had an initial gastric aspirate pH less than 2.5. The gastric pH remained in this critical range over the ensuing 4 hours in 19 (90%) of the 21 patients not receiving cimetidine. In contrast, only two (11%) of the 18 patients given cimetidine were observed to have gastric pH levels less than 3.0, 1 hour after administration. This protective effect was maintained over the subsequent 3 hours of observation. These preliminary findings warrant further clinical trial of cimetidine for the prophylaxis against aspiration pneumonitis in patients at high risk for this complication.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID