摘要:

Does ethanol affect the adrenergic response to trauma? In 52 trauma victims, grouped according to blood ethanol concentrations, we found there was a significantly higher mean plasma norepinephrine (NE) concentration in heavy imbibers than in those with no detectable blood ethanol (790 ± 84 pg/ml vs. 1,260 ± 310; p=0.02). To control confounding variables such as intensity of pain, injury severity, etc., we selected blood loss (0.9% body weight over 15 min), as an aspect of trauma to study in six normal subjects before and after ingestion of 6 oz and 10 oz of 86-proof liquor on successive days. As expected, the increase in plasma NE upon assumption of an upright position was accentuated by blood loss, (384 ± 43 pg/ml prebleed; 694 ±16 post-bleed; p=0.001). The postural or hypovolemic effect on plasma NE was enhanced by ingestion of ethanol at 6 oz prebleed (529 ± 42 pg/ml pre-ethanol vs. 732 ± 64 post ethanol; p=0.02) or at 10 oz post-bleed (694 ± 16 pg/ml vs. 1,154 ± 166; p=0.04). There was an approximate dose-response effect of ethanol on plasma NE under all conditions; for example, post-bleeding upright NE: 717 ± 57, no ethanol; 1,045 ± 221, 6 oz ethanol, and 1,257 ± 182, 10 oz ethanol. Plasma epinephrine concentrations were not significantly affected by positional changes, blood loss, or ethanol consumption. Standing systolic blood pressure (BP) fell (139 ± 71 mm Hg vs. 113 ± l l; p=0.02) as did diastolic BP (98 ± 8 vs. 79 ± 11; p=0.03) after blood loss, but ethanol ingestion did not modify the BP decrease in spite of increased plasma NE. We conclude that ethanol ingestion has a significant enhancing effect on the plasma NE response to hemorrhage. The blunting effect by the ethanol on NE vascular response may moderate the impact of adrenergic stimulation.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In recent research, hemorrhagic shock and septic shock have been studied as two separate entities. We have developed a treated model of hemorrhagic shock in which unrestrained and unanesthetized rats are bled to a mean arterial pressure of 30 torr until 80% of the maximum shed volume must be returned. Rats are maintained preshock and treated post shock with a 20% glucose-electrolyte solution. Survival of these animals is 62% at 24 hours post shock and all animals are dead at 72 hours post shock. Blood cultures obtained during shock become positive at 2 hours into the shock period and are significant compared to controls at 3 to 5 hours of shock (p<0.0001). Blood cultures obtained after the period of shock are significantly positive at 24 and 48 hours post shock (p<0.05) compared to controls. Intrashock cultures are monomicrobial; the majority of post-shock cultures are polymicrobial. All cultured organisms are normal rat enteric flora. Histologic changes of renal failure are also demonstrated post shock. We suggest that bacterial invasion, possibly from the gut, plays a role in the sepsis seen in patients following severe hemorrhagic shock. Sepsis may precede rather than follow the immune incompetence which accompanies shock.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Forty-five consecutive patients with penetrating thoraco-abdominal trauma underwent surgical exploration to evaluate the ability of peritoneal lavage to detect peritoneal penetration. Eight patients fulfilled standard criteria for operation and did not undergo lavage. The remaining 37 patients underwent diagnostic peritoneal lavage using a closed technique before exploratory laparotomy. Using 10,000 RBC/mm3as our previously established criterion for peritoneal penetration, there were seven true positive, one false positive, 28 true negative, and one false negative lavage for an overall accuracy of 94.6% with 87.5% sensitivity and 96.6% specificity as determined by subsequent laparotomy. While 33% of this patient cohort were found to have significant injuries (four had isolated diaphragmatic injuries, all detected by peritoneal lavage), 67% were subjected to negative surgical exploration, as accurately predicted by peritoneal lavage. Negative laparotomy carried a 10.7% operative morbidity. Based on these data we advocate diagnostic peritoneal lavage in patients with thoraco-abdominal penetrating trauma who otherwise lack operative indications.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The recognition of overwhelming post-splenectomy infection (OPSI) has led to greater efforts to conserve splenic tissue in patients sustaining blunt torso trauma. Nonoperative management of splenic trauma has emerged as a means to enhance splenic salvage yet criteria to assure the safety of such an approach remain ill defined and controversial. Since severity of injury directly influences outcome, a need exists for identification of splenic injuries that require early operation and repair or removal.Using our recently reported classification of splenic trauma, 46 patients with blunt splenic trauma were evaluated preoperatively with computed tomography (CT). Injuries were graded I through IV and were described as capsular or subcapsular disruptions without parenchymal injury (four); capsular and parenchymal injuries not involving the major vessels or hilum (24); injuries involving major vessels and/or the hilum (17); and fragmentation/de vascularizing injuries (one). Additional modifiers were added for associated intra-abdominal and/or extra-abdominal injuries. Sixteen patients had their splenic injuries managed nonoperatively and the remainder underwent operation for the splenic injury or associated injuries. The CT classification was confirmed in all patients and we believe early operation optimized splenic salvage.We conclude that: 1) CT is an accurate technique to determine the extent of splenic injury; 2) CT classification of splenic trauma has a high correlation with anatomic findings and need for operation; 3) early operation in patients with severe class II and all class III injuries affords optimal conditions for splenic salvage; and 4) early definitive management of splenic trauma significantly reduces late splenectomy and shortens hospitalization.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Eighty-one patients were treated for crotalid envenomation over the past 12 years at the Ben Taub General Hospital, Houston. Bites were inflicted by copperheads (56%), water moccasins (15%), and rattlesnakes (12%). In 17% of patients the species of snake was not identified. Using a grading scale of one to four from minimal to severe envenomation, 54% were grade I, 29% grade II, 7% grade III, 6% grade IV, and 4% were not graded because the patients were seen more than 12 hours after envenomation and not evaluated by other physicians. Five patients received one dose (10 cc) of crotalid antivenin each before transfer to our Emergency Center. All patients were treated with intravenous fluids, antibiotics, tetanus prophylaxis, immobilization of the injured part, and elevation of the extremity to the level of the heart. No patients received antivenin or excisional therapy at this institution and one minor digital fasciotomy was performed. There were no deaths or amputations in this series. Eight patients developed superficial necrosis of the skin but only one required a skin graft. Three patients developed hematologic abnormalities and were treated with either platelet transfusions or fresh-frozen plasma. One patient required dopamine for hypotension refractory to fluid resuscitation. This experience supports a conservative approach to venomous snakebites and raises the question about the need to utilize traditional therapy for snakebites caused by species seen in our locality.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A group of 65 head-injured patients, making an apparent good recovery, were studied with the Halstead-Reitan neuropsychological test battery because of personality or cognitive difficulty. A significant relationship was identified between outcome as measured by the Halstead Impairment Index and both Injury Severity Score and Glasgow Coma Scale score. A significant relationship was also found to exist between the Halstead Impairment Index and employment status of the study group. Patients were placed in three groups, depending on their impairment index. Of the complications identified, spinal fracture, pupillary dysfunction, and intracranial pressure elevation were consistently associated with an impaired performance on the neuropsychological testing. These findings suggest that there is a relationship between head injury complications and neuropsychological potential which can cause lingering problems and influence the patient's rehabilitation process.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The incidence, diagnosis, and impact on surgical management of myocardial contusion (MC) are incompletely defined. During a 12-month period, all patients admitted to a Level I trauma center with blunt trauma were prospectively evaluated for MC (n=1,110). Those with anterior chest wall contusions, sternal or anterior rib fractures, or pain/tenderness of the anterior chest (ra=140, 13%) underwent immediate and daily ECG, and CPK isoenzymes were measured at admission and every 6 hours in the first 24 hours. Eighty-nine of these patients underwent gated ventricular angiography (GVA) and 66 underwent two-dimensional echocardiography (2D ECHO). MC was considered present if either: 1) CPK-MB was ≥ 5% of total CPK, or 2) an abnormal admission ECG reverted to normal before patient discharge. Fifty six patients (5% of admissions, 40% of those with apparent chest trauma) were positive by one or both criteria. Thirty patients (54%) were positive by CPK alone, 23 (41%) by both CPK and ECG, and three (5%) by ECG alone. Of the 53 with elevated CPK-MB, 14 (26%) were normal on admission with the remainder becoming elevated in the first 24 hours. 2D ECHO was abnormal in only three of 21 positive patients (14%), and GVA was abnormal in only three of 40 positive patients (7%). Surgical procedures requiring general anesthesia were performed in 37 (66%) of the positive patients. No significant arrhythmias developed under general anesthesia.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To clarify the role of serum CPK-MB assays in the diagnosis of myocardial contusion, we reviewed the hospital records of 182 patients with significant blunt chest trauma and serial CPK-MB determinations. In our laboratory a serum CPK-MB/CPK ratio >2.2% is abnormal. The study group was composed of 131 men and 51 women, with a mean age of 35 years. Only six patients had histories of cardiac disease. Of 159 patients injured in vehicular accidents, 143 were drivers, nine were pedestrians, and seven were passengers. There was no relationship between the MB fraction and soft (nonspecific changes) or strongly suggestive (ectopy, focal changes) ECG signs of myocardial contusion. Two of the three patients with power failure had CPK-MB/CPK ratios <2.2%. MUGA scans, performed in 18 patients, indicated myocardial injury in seven patients; only 1/7 had abnormal 2D echocardiography, and only 2/7 had elevated MB fractions. In summary, we found no relationship between serum CPK-MB and the presence of clinically significant myocardial contusion. CPKMB determination in patients with suspected blunt myocardial injury is unjustifiably expensive ($108/assay) and adds confusion to an already vague clinical area.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The 1980 and 1985 versions of the Abbreviated Injury Scale (AIS) are quantitatively and qualitatively compared based on experience gained during the recent coding of nearly 115,000 injuries from more than 33,000 seriously injured patients using both AIS versions. Quantitative comparisons are based on differences in AIS scores and Injury Severity Score (ISS) values which result under the two schemes. Qualitative comparisons concern the completeness and clinical usability of the two scales in a trauma center setting.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID