The American surgeon
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The American surgeon · Aug 1982
Comparative StudyThe diagnostic usefulness of peritoneal lavage in penetrating trauma: a prospective evaluation and comparison with blunt trauma.
In order to assess the relative utility and reliability of peritoneal lavage as an aid in the management of patients with penetrating trauma, 709 patients (353 penetrating; 356 blunt) with trauma to the lower chest and/or abdomen were evaluated prospectively during 23 consecutive months. There were 144 true-positive, 14 false-positive, 524 true-negative, and 27 false-negative lavages for an error rate of 5.8 per cent (41/709). ⋯ The error rates were comparable in penetrating and blunt trauma; however, false-positive lavages occurred more frequently in blunt trauma and false-negative lavages occurred more frequently in penetrating trauma (p = .0022). Peritoneal lavage can be extremely useful in the initial evaluation of penetrating trauma of all types.
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Primary hemostasis, the formation of a platelet plug, was studied in 22 injured patients receiving an average of 21 transfusions during the operation for control of bleeding. The storage age of the blood averaged 15 days; no platelet transfusions were given. Platelet counts (PLT) and bleeding time (BT) were studied intraoperatively; postoperatively at 6 hours, 25 hours, day 2, day 4; and during convalescence (8 days to 3 months). ⋯ The BT remained elevated at 6 hours, 15 hours, day 2, and day 4, and declined to normal by convalescence. Thrombocytopenia and prolonged BT after massive transfusion for injury indicate platelet dysfunction which may protect against disseminated intravascular coagulation. Correction of the thrombocytopenia should be reserved for patients with bleeding.