The American surgeon
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Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1-2 RFs), 3.4 per cent in moderate (3-5 RFs), and 7.7 per cent in high (> or =6 RFs) VTE scores (P = 0.172). ⋯ First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of > or =15 and 25 had higher DVTs compared with the ones with lower injury severity score levels (P < or = 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.
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Emergency appendectomy at presentation has been the standard of care for acute appendicitis. We examined the use of antibiotics as an alternative treatment. From September 2002 to August 2003, 170 consecutive patients diagnosed with acute appendicitis without abscess were reviewed retrospectively. ⋯ One Group II patient had recurrent appendicitis (5%). The length of stay was 2.61 +/- 0.21 days for Group I and 2.95 +/- 0.38 days for Group II patients (P = 0.57). Patients with acute appendicitis may be treated safely with antibiotics alone without emergency appendectomy.
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The American surgeon · Oct 2007
Reanalysis of prehospital intravenous fluid administration in patients with penetrating truncal injury and field hypotension.
In 1994, Bickell et al. published a prospective study recommending restricting prehospital intravenous fluids (IVF) to less than 100 cc in patients with penetrating truncal injuries and field hypotension, reporting a 30 per cent mortality with IVF restriction and a 38 per cent mortality with liberal IVF use. However, since this study, few papers have investigated whether emergency medical systems (EMS) adhere to these IVF guidelines. The purpose of this study was to determine whether a policy of IVF restriction is being followed and whether the volume of prehospital and emergency department (ED) IVF affects outcome in patients with penetrating truncal injury and field hypotension at a Level I trauma center in Los Angeles County. ⋯ It appears that the recommendations of IVF restriction for patients with penetrating truncal injuries and field hypotension are not being followed by Los Angeles County EMS. There were no differences in survival with respect to the amount of prehospital or ED IVF. Given the retrospective nature of this study, further investigation is needed to define the role of prehospital IVF resuscitation in these patients.
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The American surgeon · Oct 2007
The correlation of near-infrared spectroscopy with changes in oxygen delivery in a controlled model of altered perfusion.
Alterations in regional tissue perfusion may precede global indications of shock. This study compared regional tissue oxygenation saturation (StO2) using near-infrared spectroscopy with standard hemodynamic and biochemical variables in 40 patients undergoing cardiopulmonary bypass (CPB). Mean arterial pressure, cardiac output, oxygen delivery, arterial blood gases, and lactate were recorded at specific intervals during surgery. ⋯ Additionally, a decrease in StO2 corresponded with an increase in base deficit of 4.84 (standard deviation +/- 2.37) mEq/L over the same period. Calculated oxygen delivery decreased from a baseline value of 754 (IQR, 560-950) mL/min to 472 (IQR, 396-600) mL/min with initiation and maintenance of CPB. For patients undergoing CPB, StO2 is a reliable, noninvasive monitor of perfusion, which correlates well with oxygen delivery and identifies perfusion deficits earlier than lactate or base deficit.