American journal of surgery
-
Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. ⋯ Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.
-
Penetrating injuries of the subclavian artery occurs infrequently but represent a surgical challenge. We reviewed our experience with penetrating injury of the subclavian artery and identify factors that influenced morbidity and mortality. ⋯ Penetrating injuries of the subclavian artery are associated with high morbidity and mortality. Multiple concomitant injuries, unstable vital signs upon presentation, and gun shot injuries greatly increase mortality.
-
Central venous catheters are placed frequently at our institution. Residents are taught the technique of subclavian line placement starting in their first year of training. ⋯ We have developed a method of fixation for subclavian central venous catheters that provides a safe, secure, and convenient means of fixation to the chest wall. The central venous catheter can be inserted by that technique with which the physician is the most comfortable and familiar.
-
Comparative Study
Differential nitric oxide synthase expression during hepatic ischemia-reperfusion.
In recent years the important role of nitric oxide in hepatic ischemia-reperfusion injury has been increasingly recognised. The prevailing consensus is that reperfusion injury may be partly the result of decreased production of nitric oxide from endothelial nitric oxide synthase and excessive production of nitric oxide from the inducible isoform. We therefore undertook this study to characterize the expression of different nitric oxide synthase isoforms during hepatic reperfusion. ⋯ During the reperfusion period after hepatic ischemia, endothelial nitric oxide synthase is downregulated while inducible nitric oxide synthase is expressed in both hepatocytes and inflammatory cells. The presence of nitrotyrosine in livers subjected to hepatic ischemia-reperfusion suggests that the expression of inducible nitric oxide synthase plays an important role in mediating reperfusion injury in this model.
-
To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. ⋯ Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.