The American surgeon
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The American surgeon · Apr 1988
Rapid sequence induction with oral endotracheal intubation in the multiply injured patient.
The charts of 1798 consecutive admissions at this level one trauma center to evaluate the practice of emergency airway control were reviewed. A total of 335 patients required endotracheal intubation, 320 oral endotracheal, 12 nasotracheal, and three surgical. A technique of rapid sequence induction (RSI) with oral endotracheal intubation was the method of airway control in 260 spontaneously breathing patients. ⋯ In all instances airway control was prompt and accurate. There were no hemodynamic nor neurologic complications secondary to RSI or oral endotracheal intubation. It is believed that RSI with oral endotracheal intubation is a reasonable alternative to nasotracheal intubation in the spontaneously breathing patient.
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The American surgeon · Mar 1988
Intra-aortic balloon cardiac assist: complication rates for the surgical and percutaneous insertion techniques.
A retrospective study was performed to evaluate complications with the two most common intra-aortic balloon pump (IABP) insertion techniques. During a nine year period, 202 patients (51 women, 151 men) underwent IABP cardiac assist utilizing the arteriotomy surgical (103 balloons) and percutaneous (99 balloons) insertion techniques. Complications, including asymptomatic loss of pedal pulse, vascular-symptomatic, infection, or balloon rupture occurred in 22.8 per cent of patients. ⋯ The number of patients requiring surgical intervention or removal was not significantly different between the surgical and percutaneous methods (9 versus 18%, P = .06). While the method of IABP insertion did not significantly alter hospital mortality, a significantly greater complication rate was observed with percutaneous insertion (P = .007). This was particularly relevant to complications occurring at the time of removal of IABP.
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The American surgeon · Jan 1988
Comparative StudySurface oximetry. A new method to evaluate intestinal perfusion.
Accepted methods to evaluate intestinal vascularity intraoperatively include standard clinical criteria (SCC), doppler ultrasound (DUS), and intravenous fluorescein (FLF). A combination of methods is often used to overcome disadvantages of individual techniques. ⋯ POX uses a commercially available instrument to assess tissue oxygenation and arterial flow, and is rapid, reproducible, and noninvasive. POX appears to be a superior technique when compared to SCC and DUS.
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Hypothermia is a frequent complication of severe hemorrhagic shock and can complicate the treatment of trauma patients. The authors have investigated the effect of external warming on a treated model of hemorrhagic shock in rats. Their data show that externally heating the animal during the shock period decreases the animal's ability to withstand shock and increases intrashock and postshock mortality when compared to nonheated controls. The authors have also shown that nonheated animals that can retain body heat by passive retention can withstand increased shock time and have an increased postshock survival.
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A ten-year experience with 83 chemical burns is reported. With the exception of phenol burns and lithium burns, immediate copious water irrigation is recommended at the scene of the injury. Specific additional measures for certain chemicals are discussed.