The American surgeon
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Nonoperative management of stab wounds of the abdomen is currently practiced in many trauma centers; this report examines the role of expectant management of gunshot wounds to the abdomen in a select patient population. Patients presenting to a single trauma service from 5/91 to 1/94 at Detroit Receiving Hospital with a gunshot wound (GSW) to the abdomen fulfilling the following criteria were observed: 1) single GSW to the right upper quadrant, 2) stable vital signs, 3) reliable examination with minimal abdominal tenderness and available team/operating room, and 4) minimal or no abdominal tenderness. ⋯ The role of expectant therapy of abdominal gunshot wounds is cautiously advanced. With appropriate criteria, this technique appears safe and efficacious.
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Poor outcomes following transcranial gunshot wounds (TC-GSW) and the perception of significant financial loss have led some institutions to adopt a fatalistic attitude towards these patients. This study was undertaken to define those factors predictive of mortality following TC-GSW as well as to determine the costs and benefits associated with providing care to these individuals. We reviewed the medical records of 57 TC-GSW patients seen at our Level I Trauma Center between January 1990 and December 1992. ⋯ Nonsurvivors who became organ donors were clinically and demographically indistinguishable from those in whom organs/tissues could not be retrieved. Despite the poor outcome following TC-GSW, vigorous resuscitation and stabilization is justified in all patients, in that nearly one half of nonsurvivors will become organ and/or tissue donors. Concerns regarding excessive monetary looses by treating facilities are unfounded.
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The American surgeon · Aug 1995
Central venous oxygen saturation, arterial base deficit, and lactate concentration in trauma patients.
Our object was to explore the usefulness of central venous oxygen saturation, arterial base deficit, and lactate concentration in the evaluation of trauma patients. In busy urban trauma centers, limited operating room availability may necessitate that certain hemodynamically stable patients experience some delay between diagnosis of injury and surgery. Because hemodynamic compromise may occur before operation is undertaken, some means of identifying those patients who have the most severe injuries or who are at greatest risk for hemodynamic instability would be useful. ⋯ ScvO2 did not significantly correlate with any of the parameters of blood loss and severity of injury examined. However, both base deficit and lactate concentration correlated with transfusion requirements; in addition, base deficit correlated with trauma score, and lactate correlated with peritoneal shed blood volume. Our data suggest that, after resuscitation, arterial base deficit and lactate concentration may be better indicators of blood loss than is ScvO2.
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The American surgeon · Aug 1995
Gunshot wounds to the thoracic aorta in the '90s: only prevention will make a difference.
The clinical experience with gunshot injuries to the thoracic aorta at a large urban trauma center was reviewed. Of 1961 patients admitted with gunshot wounds to the chest, 20 sustained injuries to the thoracic aorta. ⋯ Only two patients were stable enough for aortography. Advances in the management of critically injured patients have not improved the outcome with this lethal injury.
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The American surgeon · Aug 1995
Comparative StudyEffect of resuscitation solutions on the immune status of dogs in hemorrhagic shock.
The purpose of this study is to examine the effects of three different types of fluid resuscitation on the immune system of dogs in hemorrhagic shock. Using a modified Wigger shock model, 18 conditioned male dogs were bled to mean arterial blood pressure of 60 mm Hg for 90 minutes and placed into three groups based on the resuscitative method. Group I: Crystalloid Resuscitation; Group II: Autotransfusion; Group III: Banked Blood. ⋯ Cellular immunity was also affected by transfusion. Total lymphocyte count was increased in Group II on Day 1; however, the three groups were similar with respect to this variable on subsequent days. The absolute T4 helper cell level in Group II was similar to Groups I and III until Day 7, at which time the level became higher in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)