Annals of emergency medicine
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To determine the relative predictive value of the arterial base deficit (BD) as an indicator of intra-abdominal injury (AI) and to compare BD with other indicators (chest injuries, pelvic fractures) of AI. ⋯ BD is a powerful indicator of AI. A normal BD does not exclude AI, but the presence of a BD less than or equal to -6 in a blunt trauma patient should be considered a strong indication for objective evaluation of the abdomen (ie, diagnostic peritoneal lavage).
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Case Reports
Continuous intravenous infusion fentanyl for sedation and analgesia of the multiple trauma patient.
Fentanyl is an attractive agent for analgesia in the emergency department. Its use in this setting has been limited to IV bolus administration. We report successful sedation, muscle relaxation, and analgesia of a multiple trauma patient with fentanyl IV bolus and continuous infusion in the ED.
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To determine the role of lavage amylase (LAM) and lavage alkaline phosphatase (LAP) in the identification of intraperitoneal hollow visceral injuries. ⋯ In patients with hollow visceral injury and otherwise normal diagnostic peritoneal lavage, elevation in LAM is highly specific for isolated small bowel injury. Lavage enzyme determinations appear unhelpful in the detection of colonic injury. We recommend routine enzyme determinations of lavage effluent as a marker for isolated small bowel injury.
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To determine the utility of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) in predicting intra-abdominal injury in blunt trauma patients. ⋯ Elevation of serum levels of the study enzymes is a marker for intra-abdominal injury. Levels in excess of 130 IU/L are relative indicators of abdominal computed tomography scan. Levels of less than 130 IU/L are unlikely to be associated with liver injury.
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Case Reports
Cardiac rupture secondary to blunt trauma: a rapidly diagnosable entity with two-dimensional echocardiography.
A 58-year-old woman involved in a single automobile accident sustained an isolated rupture of the right ventricle without any other obvious form of external trauma. On presentation to an outlying hospital, hypotension was the only apparent clinical finding suggestive of injury. ⋯ The diagnosis of cardiac rupture was made by two-dimensional echocardiography. The patient underwent successful surgical repair and was discharged home in good condition eight days after sustaining this potentially fatal injury.