Clinics in laboratory medicine
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Explosions may have varied energy sources, reasons for occurring, and ways of injuring or killing. Careful analysis of the explosion scene, coupled with an equally careful examination of surgical or autopsy material as the result of an explosion, contributes greatly to the investigation. Surgical or autopsy material suspected of having been injured by explosion should be carefully photographed and x-rayed, swabbed with chloroform-soaked swabs, then swabs soaked in 0.1N hydrochloric acid, cleaned meticulously while collecting only surface fragments, photographed and x-rayed again, and then searched extensively for fragments.
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Experimental and clinical aspects of fluid management problems are reviewed; clinical and physiological criteria for efficacy of various plasma expanders are evaluated. Reduced extracellular water is considered the primary defect of shock by those favoring the use of crystalloids, but hypovolemia is regarded as primary by those favoring the use of colloids. ⋯ In general, colloids improved hemodynamic and oxygen transport, while sodium-rich crystalloids increased arterial pressure and peripheral resistance, but not flow and oxygen transport. Indications for various agents and protocols (clinical algorithms) for resuscitation and critical illness are proposed.