Angiology
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A prospective clinical study was undertaken in 50 consecutive patients suffering from severe traumatic shock to evaluate the clinical efficacy of a set for rapid administration of solutions (RSAS), which allows for rapid infusion and simultaneous warming of blood and fluids. The mechanism of injury was blunt in 37 patients and penetrating in 13. Admission trauma score averaged 7.5, and the injury severity score averaged 46. ⋯ Survival at twenty-four hours was 29/50 (58%). There were no local complications of RSAS use and no evidence of infusion-related coagulopathy. The RSAS provided an effective and safe way to infuse large volumes of blood and fluid at body temperature.
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Case Reports
Phlegmasia cerulea dolens and its association with hypercoagulable states: case reports.
Six patients who developed phlegmasia cerulea dolens are described. All patients had associated hypercoagulable states: heparin-induced thrombocytopenia (2 patients), congenital deficiency of protein C (1 patient), and antithrombin III deficiency (3 patients). ⋯ Phlegmasia cerulea dolens is a life- and limb-threatening complication. An appreciation of underlying hypercoagulable states is essential to proper management, prophylaxis, and treatment of this disorder.
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Two cases of catheter embolization from implanted venous access devices are reported and the available literature is reviewed. The catheter from an implanted venous access device migrated into the right heart after slippage of the O-ring, which attaches the catheter to the infusion port. The distal 6 cm of an infusion port catheter embolized to the right heart after spontaneous fracture of the catheter at the point where it passed between the clavicle and first rib. ⋯ Risk factors for embolization were apparent on x-ray films with evidence of O-ring slippage in 1 case an obvious kinking of the catheter in the other. Symptoms of embolization included chest discomfort, right upper quadrant pain, and nausea. In 1 case, an extra heart sound, initially thought to be an S3, disappeared when the catheter was removed.
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The finding of second-degree and high-grade atrioventricular block in a patient with severe accidental hypothermia is described. Additional findings included atrial fibrillation, severe sinus bradycardia, and prominent J (Osborn) waves. This case represents, to the authors' knowledge, the first report of advanced spontaneous AV block not induced by atrial pacing in severe accidental hypothermia. Reversal of the block, and other characteristic changes, suggest a relationship to low temperature.
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Under certain conditions laser Doppler flowmeter (LDF) signals obtained from the finger pulp may appear very similar to those obtained by use of a direct current (dc) photoplethysmograph (PPG). A combined LDF/PPG system was used in conjunction with a circumference strain gauge as an index of volume change to identify the conditions in which the correlation between these signals was good. Simultaneous LDF and dc PPG measurements were made on 10 normal volunteers by using arterial occlusion and on 7 normal subjects by using the Valsalva maneuver at different elevations of the forearm and hand with respect to the midsternum. ⋯ The dc PPG signal may be used as a means of monitoring changes in blood flow in the finger only when venous filling is low and the return remains unrestricted. Thus, in investigations using this method, the relative position of the limb with respect to the heart should always be indicated. The LDF method appears to be a reliable indicator of blood flow changes in the microcirculation irrespective of the degree of venous filling.