The American surgeon
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The American surgeon · Apr 2013
Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation.
This study tests the hypothesis that a change in hematocrit (ΔHct) during initial trauma work-up is as reliable as conventional vital signs for detecting bleeding, even with ongoing fluid resuscitation. Consecutive trauma patients admitted to a Level I trauma center receiving two Hct measurements during initial resuscitation between January 2010 and January 2011 were stratified based on estimated blood loss greater than 250 mL (bleeding) or nonbleeding. Sensitivity, specificity, and receiver operating characteristic curves were calculated for systolic blood pressure (SBP), heart rate, base deficit, and ΔHct. ⋯ During ongoing fluid resuscitation of a trauma victim, ΔHct is the single most reliable indicator of continuing blood loss. A ΔHct 6 or greater during initial resuscitation is highly suspicious for ongoing blood loss, but even lesser changes have predictive value. Altogether, these results support the idea that fluid shifts are rapid after hemorrhage and Hct can be valuable during initial trauma assessment.
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The American surgeon · Apr 2013
Biography Historical ArticleThe first pediatric operation performed under anesthesia.
A number of articles and chapters in the pediatric anesthesia credit the first use of ether anesthesia to Crawford Long in an operation performed on an 8-year-old male slave. However, Long never gave the ages of any of his patients in any of his letters, articles, or communications. The 1840 and 1850 federal censuses give ages but no names for male slaves, two of whom are candidate patients. ⋯ The second was younger than 15 years and was identified as a child by a student working with Long. Thus, the date of the first pediatric anesthetic where documentation is reasonably certain is January 8, 1845, given the limitations in the use of slave censuses. After the Ether Dome demonstration in 1846, ether anesthesia for children was rapidly adopted in Boston and London.