American journal of surgery
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Results of our retrospective review of 100 consecutive patients show that early intramedullary nailing can be accomplished in severely injured patients without increasing the risk of fat embolism syndrome. No cases of fat embolism syndrome were seen after immediate (less than 24 hours) intramedullary nailing of femoral shaft fractures. ⋯ This is attributed to the greater severity of injury present in the patients selected for immediate intramedullary nailing (injury severity scores 23.2 in immediate group; 12.4 in delayed group). The incidence of critical hypoxemia in the immediate group was equivalent to that in another group of injured patients who did not have fractures, but who did have similar injury severity scores.
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Transcutaneous oxygen sensor values reflect peripheral oxygen tensions. During shock and resuscitation, transcutaneous oxygen sensor values depend on peripheral blood flow, and, therefore, reflect cardiac output and oxygen delivery. Transcutaneous oxygen sensor monitoring, therefore, should be quite useful when caring for acutely ill patients; data from 20 surgical emergency department patients support this hypothesis. ⋯ In addition, transcutaneous oxygen sensor was useful for continuous monitoring during resuscitation. Successful correction of hypoxia and perfusion deficits results in increased transcutaneous oxygen sensor values. Failure of the transcutaneous oxygen sensor value to increase during resuscitation implies ongoing deficits of tissue oxygenation.
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Opiates such as morphine have a direct spinal effect, acting at special receptor sites in the dorsal horn. When morphine is administered epidurally, it diffuses to the cord substance, producing analgesia of improved quality after a dose of 2 to 4 mg. ⋯ Significant side effects are uncommon, but pronounced respiratory depression can occur late and careful observation is necessary. The first instance of paraplegia in association with epidural morphine anesthesia has been reported herein.