The American surgeon
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The American surgeon · Feb 1986
Case ReportsContinuous monitoring of mixed venous oxygen saturation during aortofemoral bypass grafting.
Measurement of mixed venous oxygen saturation (SvO2) may be helpful in the care of critically ill patients. Serial determinations of SvO2 give an index of the relationship between oxygen delivery and tissue oxygen consumption. ⋯ Continuous monitoring of mixed venous saturation may be helpful in high risk or critically ill general and peripheral vascular surgery patients both in the intensive care unit and in the operating room. The following clinical report is presented to illustrate the usefulness of continuous SvO2 monitoring in a high risk vascular surgery patient.
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The treatment of 77 patients with wounds of the inferior vena cava admitted to Grady Hospital, Atlanta, Georgia, from January 1972 through December 1983, was reviewed. All injuries were identified by laporotomy and/or thoracotomy. Trauma resulted from gunshot wounds in 79 per cent of patients, stab wounds in 18 per cent, and blunt trauma in 3 per cent, with an overall mortality of 30 per cent. ⋯ Of the 29 patients with at least one additional injury to a major vascular structure, 45 per cent died. The mortality of infrarenal and suprarenal injuries was relatively low (22% and 33% respectively), compared with retrohepatic and supradiaphragmatic injuries, both of which were fatal in 67 per cent of the cases. Despite advances in the care of the trauma patient, significant improvement in survival has not occurred, and the patient mortality has remained at 30 per cent.
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The American surgeon · Jan 1986
Emergency department thoracotomy (EDT). A 26-month experience using an "agonal" protocol.
EDT can be successfully performed with the proper system in place. This includes an established thoracotomy protocol, a well-integrated EMS system, and an in-house team. Time seems to be critical, and the time between injury and EDT may be the single most important factor affecting survival other than the mechanism of injury. ⋯ The protocol should be one that will allow maximum selection of patients who can benefit and elimination of those patients where EDT would be useless. The primary benefactor for EDT remains the patient sustaining a stab wound to the heart who arrives at the center shortly after injury. In other areas, such as abdominal exsanguination or severe blunt injury, further study is needed to determine what factors, prehospital and resuscitative, will improve outcome.
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Alcohol has been demonstrated to produce cutaneous vasodilation. The burn wound is characterized by a compromised microcirculation which is amenable to pharmacologic manipulation to improve the final outcome of the injury. ⋯ Preburn administration of ethanol significantly improved the mean burn severity at 48 hr compared to ethanol given post-burn. Ethanol, acting as a vasodilator, improves dermal circulation post-burn and reduces the overall extent of injury.
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The American surgeon · Jan 1986
Biography Historical ArticleJulian John Chisolm, M.D. Confederate surgeon.