American journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Diuresis with continuous infusion of furosemide after cardiac surgery.
We prospectively evaluated the diuretic effect of furosemide administered by bolus injection and by continuous infusion in 18 cardiac surgery patients. Nine patients were randomly assigned to receive 0.3 mg/kg of furosemide as a bolus injection at time 0 and again 6 hours later (nine patients) or 0.05 mg/kg per hour of furosemide as a constant infusion for 12 hours (nine patients). ⋯ Diuresis during continuous infusion of furosemide was less variable from hour to hour than after bolus injection of furosemide and was sustained throughout the infusion period. Although the continuous infusion of furosemide will not provide the rapid and vigorous diuresis that is necessary in some clinical situations, it may be useful whenever a gentle, sustained diuresis is desired.
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Tar and asphalt burns are unique injuries because the chemical is difficult to remove without inflicting further tissue injury. Since 1978, 42 patients have been treated for hot tar or asphalt injuries, 30 of whom required hospitalization. Inpatients were all male with a mean age of 27.2 years and a mean burn size of 9.3 percent total body surface area (mean full-thickness injury 5.3 percent total body surface area). ⋯ This solvent proved nonirritating and removed tar much faster than other agents. Early excisional therapy was performed in 63.4 percent of the patients, 80 percent of whom returned to work within 6 weeks of injury. Principles of management include rapid cooling of tar or asphalt to solidify the inciting agent and dissipate heat; removal with a new, non-toxic solvent; early excision and grafting of appropriate injuries; and an aggressive, early back-to-work philosophy.
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Computerized tomography has proved useful in the evaluation of selected patients suffering blunt abdominal trauma. Seventeen patients with major multisystem injuries were treated using a protocol involving abdominal computerized tomographic scans for evaluation of intraabdominal injury. ⋯ The remainder of the patients with intraabdominal solid organ injury diagnosed by computerized tomographic scan were followed under strict guidelines and recovered without surgery. Computerized tomography represents a quick, accurate diagnostic technique for dealing with blunt abdominal trauma in selected multiply injured patients.
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The data derived from 105 severe pelvic fractures have provided guidelines for managing paralytic ileus associated with fracture. Fracture types I, II, IV, and double type III can be treated expectantly with a high degree of confidence that ileus will resolve within 2 days. ⋯ However, should ileus in patients with diametric fractures continue longer than 5 days, parenteral nutrition should be started, since ileus will persist for an average of 2 weeks. A direct correlation between type of pelvic fracture, amount of retroperitoneal blood, loss and duration of ileus has been documented.