International journal of surgery
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Increasing numbers of severely injured patients have been presenting to Emergency Rooms worldwide due to advances in pre-hospital trauma care. Some of these patients may be candidates for Emergency Department Thoracotomy (EDT). Large advisory bodies have identified selection criteria for EDT in Developed Countries, but there are no regional statistics to guide the selection process in Developing Caribbean Nations. ⋯ Several health care limitations have been uncovered in this setting that must be improved if we are to expect improved outcomes. Focused preparation of the Emergency Room is an initial step that can be easily achieved. We also need to define strict management protocols using selection criteria that are tailored to our local environment in order to exclude futile procedures in unsalvageable patients.
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Retaining an appropriate level of moisture at the interface between a healing wound and an applied dressing is considered to be critical for effective wound healing. Failure to control exudate at this interface can result in maceration or drying out of the wound surface. The ability to control moisture balance at the wound interface is therefore a key aspect of wound dressing performance. ⋯ The composite hydrofibre dressing retained moisture at the wound interface throughout the experiments while areas of the foam dressing quickly became dry, even during constant injection of fluid. The abundance of sensors allowed a moisture map of the surface of the wound dressing to be constructed, illustrating that the moisture profile was not uniform across several of the dressings tested during absorption and evaporation of liquid. These results raise questions as to how the dressings behave on a wound in vivo and indicate the need for a similar clinical monitoring system for tracking wound moisture levels.
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Randomized Controlled Trial Comparative Study
Comparison of postoperative pain management techniques on endocrine response to surgery: a randomised controlled trial.
The present study compared three postoperative pain management techniques in patients undergoing lower abdominal surgery: intermittent opiate regimen (IOR), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA), on cortisol and prolactin levels during the first 48 h postoperatively. Ninety-two patients scheduled for a lower abdominal surgery, were randomly assigned to one of three study groups: IOR (N=31), PCA (N=31), and PCEA (N=30). Patients of the IOR group received postoperatively 50-75 mg of pethidine IM on demand. ⋯ Patients of the PCEA group exhibited diminished postoperative elevation of serum cortisol levels at 24 and 48 h (24.4, 18.6 microg/dl, respectively) compared with both IOR (31.9, 21.9) and PCA (28.5, 22.3) groups. Similarly, patients of the PCEA group exhibited diminished postoperative elevation of serum prolactin level (20.7, 15.7 ng/mL) compared with PCA (24.9, 17.1) group. The present results indicate that the PCEA technique offers an advantageous treatment associated with reduced postoperative pain, and attenuated neuroendocrine response.
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The abdomen is routinely considered as a possible source of bleeding in hypotensive and unevaluable blunt multitrauma patients. These patients are often unstable to be transported for abdominal computed tomography (CT). Emerging data on Focused Assessment with Sonography for Trauma (FAST) exam questions its initially reported high accuracy. We hypothesized that Diagnostic Peritoneal Aspiration (DPA), without a full lavage, accurately detects intraperitoneal blood if present in sufficient volume to cause hypotension and warrant emergent operation. ⋯ Percutaneous DPA is accurate, rapid, safe, and superior to FAST for the diagnosis of abdominal blood as the source of hemodynamic instability, requiring emergent surgery, in blunt multitrauma patients.