The American surgeon
-
Mechanical ventilatory support requiring tracheal intubation may be necessary for variable lengths of time in injured patients. Criteria useful in predicting the need for prolonged tracheal intubation has not been clearly established in the trauma population. Early identification of patients requiring prolonged tracheal intubation and mechanical ventilatory support could lead to earlier tracheostomy and subsequent reductions in complications associated with prolonged endotracheal intubation. ⋯ At ages of 40 to 60, GCS < or = 7 and (A-a)O2 > or = 150 indicated the need for long term mechanical ventilatory support. In older patients (age > or = 80), GCS < or = 7 and (A-a)O2 gradient > or = 100 were predictive of long-term mechanical ventilatory support. Appropriate use of these clinical indicators may assist in early identification of patients requiring prolonged mechanical ventilatory support, and subsequent conversion from endotracheal intubation to tracheostomy with anticipated reduction in complications.
-
A retrospective study was performed to evaluate the use of abdominopelvic computed tomography of the abdomen (CTA) in the initial evaluation of hemodynamically stable blunt trauma patients. Two hundred fifty-six of 2,047 injury admissions over a 2-year period underwent CTA. Sixty-two (24.2%) scans were positive for visceral injury. ⋯ When indications included early need for nonabdominal operation, only three of 41 scans were positive. Yield for patients scanned with obtundation as an isolated indication was diminished. Cost of CTA exceeds that of DPL, but lower procedure-related risk and lower estimated rate of nontherapeutic laparotomy leads to clinical favor of CTA in this group of patients.
-
The American surgeon · Dec 1995
Review Case ReportsPneumatosis intestinalis and portal venous air associated with needle catheter jejunostomy.
Pneumatosis intestinalis is an unusual postoperative complication. In some cases, immediate surgical intervention may be necessary. This report describes pneumatosis intestinalis with portal venous air attributed to enteral nutritional support via needle catheter jejunostomy. The etiology, radiographic findings, and management of this problem are reviewed.
-
The American surgeon · Dec 1995
An unsuspected cause for recurrent angina: subclavian artery stenosis.
The advantages of internal mammary artery (IMA) grafts over saphenous vein grafts (SVG) for coronary artery bypass grafting have been extensively recorded in the literature. Operative results and postoperative mortality in patients with IMA versus SVG are comparable. The relative risks of thrombosis, however, of an SVG are four to five times greater than an IMA graft, and the probability of recurrent angina or need for reoperation is significantly less in IMA grafted patients. Coltharp et al. also showed that the risks of reoperation for recurrent angina were decreased by a previously constructed IMA graft.
-
The American surgeon · Nov 1995
Review Case ReportsPharyngo-esophageal perforation due to blunt trauma.