The American surgeon
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The American surgeon · Dec 1991
Diaphragmatic injuries: recognition and management in sixty-two patients.
Between 1979 and 1989, 62 patients were treated for traumatic injury of the diaphragm. Forty-five had penetrating injuries following stab wounds or gunshot wounds, and 17 had diaphragmatic tears from motor-vehicle and auto-pedestrian accidents. Forty-one patients sustained left-sided injuries; 20 patients sustained right sided injuries; and one patient sustained bilateral ruptures. ⋯ Bony fractures, splenic injuries, and head trauma were more commonly found with blunt diaphragmatic ruptures. The average hospital stay for the penetrating injuries was 11 days and for blunt trauma was 16 days. The operative mortalities was 2 per cent for penetrating injuries and 12 per cent for blunt injuries.
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The American surgeon · Dec 1991
Evaluation of a comprehensive algorithm for blunt and penetrating thoracic and abdominal trauma.
The objective was to develop a single branched-chain decision tree for both blunt and penetrating thoracic and abdominal trauma and to test its feasibility to track clinical decisions. The algorithm consisted of 14 specific patient management loops and 31 decision nodes. During a 4-month period, the management decisions and clinical course of 434 trauma patients were prospectively observed. ⋯ There were 108 patients with ISS scores between 20 and 50. In this group, mortality was 55 per cent when a major deviation occurred and 5 per cent without major deviations from the algorithm. The authors conclude that the survival of trauma patients may be improved by following the specific management criteria outlined by the algorithm.
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The authors studied the impact of intensive care unit (ICU) acquired nosocomial infections on surgical patients stratified by severity of illness before acquisition of the infection. Data were analyzed from 2,122 consecutive patients admitted to a 20 bed surgical intensive care unit (SICU) from January 1, 1988 to December 31, 1988. The simplified acute physiology score (SAPS), a measure of illness severity that correlates with mortality, was calculated for all patients on their first SICU day. ⋯ The authors found that the monthly incidence of isolates of Xanthomatous maltophilia, a multiply-resistant nosocomial organism, reflected the overall incidence of nosocomial infections in the SICU. They observed a decline in the number of new X. maltophilia isolates and nosocomial infections concomitant with the introduction of gown and glove contact isolation procedures. The authors conclude that nosocomial infections in the SICU setting are directly related to increased patient morbidity and mortality depending, in part, on severity of illness upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Dec 1991
The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.
Hypervolemia from fluid overload with resultant pulmonary edema is thought to be a frequent cause of Adult Respiratory Distress Syndrome (ARDS). However, ARDS may also occur as a result of the hypovolemic shock of surgery or trauma. To develop an appropriate rationale for fluid therapy in high-risk surgical patients, the relationship between fluid balance, hemodynamics, the onset of ARDS by physiologic criteria (shunt greater than or equal to 20%, and/or PaO2/FiO2 ratio less than 250) and the onset of pulmonary infiltration (PI) associated with ARDS were examined. ⋯ ARDS by physiologic criteria occurred in 29 of 50 (58%) patients; 27 of these 29 (94%) also developed +2 or greater PI. The mean onset times of ARDS and of +2 PI were 40 +/- 41 hours and 40 +/- 38 hours, respectively. The ARDS patients had a significantly smaller net positive fluid balance than the non-ARDS patients over the first 40 hours after admission (+6,831 ml +/- 4,909 ml vs 12,440 ml +/- 7,817 ml, (P less than 0.01)).(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Dec 1991
Comparative StudyTransfusion therapy in cardiac surgery: impact of the Paul Gann Blood Safety Act in California.
The Paul Gann Blood Safety Act became law in California on January 1, 1990, mandating that patients be informed of the risks and alternatives of blood transfusions. To evaluate the impact of this legislation, the authors compared transfusion therapy in patients undergoing cardiac surgery during 1990 to previous years (1986 to 1987 and 1989). Surgical techniques were unchanged. ⋯ The number of patients not requiring transfusions increased from 28 per cent in 1989 (61 of 219) to 47 per cent in 1990 (104 of 222). A slight but significant decrease in cardiopulmonary bypass time and perioperative blood loss occurred. The authors conclude that this legislation stimulated the surgical team to control blood loss during surgery and to avoid the anticipatory use of component transfusions.