The American journal of emergency medicine
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Comparative Study
A community-based comparison of trauma patient outcomes between D- and L-lactate fluids.
Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, D- and L-lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d-lactate on vital organs. Using an administrative database, we examined whether D- or L-lactate volume was associated with mortality in patients with trauma. ⋯ Because early administration of D-lactate was associated with mortality and ventilation, physicians and policy makers should recognize the advantages of L-lactate and encourage research on the quality of d- and l-lactate in case mixes beyond trauma.
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Randomized Controlled Trial
Isolated sternal fractures treated on an outpatient basis.
The aim of this study is to investigate the need for admission of patients with isolated sternal fracture (ISF) by prospectively and randomly discharging or admitting them. ⋯ Patients with ISF can be discharged safely as soon as investigations are completed. Extensive myocardial assessment is not needed on the posttraumatic period. Myocardial involvement seems unlikely in patients with ISF, who can be treated with oral analgesics.
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Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage. ⋯ As a result, TCM worsened further the general condition of the patient. There is a high possibility that TCM and hypovolemia can be closely related, and therefore, the treatment of hypovolemia can be adjusted to new standards. Because it has already been proved that TCM can be induced by emotional stress and various pathological entities, further investigations are necessary.
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Our aim in this study was to use ultrasonography of internal jugular vein (IJV) instead of visual estimation by eye and to get more precise estimation of central venous pressure at supine position for estimating blood loss in healthy volunteers. ⋯ Although, the IJV collapse index was not found to be a useful parameter for evaluation of hypovolemia, cIJV LL is more valuable marker for the detection of blood loss at bedside.
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The most frequent cardiac pathologies caused by electric shock are arrhythmias with a wide clinical picture ranging from sinus tachycardia to asystole. Cardiac mechanical complications secondary to electric shock have rarely been reported. ⋯ In this study, we have presented the rupture in the secondary chordae of the mitral anterior leaflet caused by low-voltage electrical trauma. To our knowledge, this is the first cardiac mechanical complication reported as a consequence of low-tension electrical trauma.