The American surgeon
-
The American surgeon · Apr 1984
Historical ArticleLife Saver: a complete team approach incorporated into a hospital-based program.
Both military and civilian settings have shown that a team approach through an excellent prehospital Emergency Medical Services system, an organized regional communication system, access to rapid air evacuation with a "complete" medical team on board, and dedicated trauma resources allows a critically ill or injured patient optimal chances for survival. The Life Saver airborne emergency service, operated by Carraway Methodist Medical Center in Birmingham, Alabama, is a "complete team" concept with a well trained emergency physician and a critical care flight nurse aboard every flight. The physician upgrades the level of care at the scene of an accident, lessens the referring physician's anxiety, maintains an intensive care unit environment during transport and intervenes if a life threatening emergency occurs, which cannot be predicted prior to lift-off. ⋯ Trauma transports accounted for 47.5%, nonsurgical problems 47.8% and nontraumatic surgical patients representing the remaining 4.7%. The in-flight mortality was 0%. This type service is not appropriate for all hospitals to provide, but should be considered by major trauma and cardiac referral centers.
-
The American surgeon · Apr 1984
Case ReportsCombined skeletal and vascular injuries of the lower extremities.
In order to determine the long-term results of surgical treatment in patients with significant combined skeletal and arterial injuries, the authors reviewed the records of those patients treated for this injury between 1970 and 1981, at their institutions. These cases were confined to fractures and/or dislocations of the femur, knee, and tibia which were associated with vascular injuries. Thirty-one patients with 32 injured extremities fit these criteria for our review. ⋯ Two extremities had a poor result. Four extremities were primarily amputated, and secondary amputation was performed on seven extremities. Associated nerve deficits and/or significant soft tissue injuries were found to be the major factors determining the eventual success or failure of reconstructive efforts.
-
The American surgeon · Mar 1984
Case ReportsManagement of penetrating hepatic injury. A review of 102 consecutive patients.
The records of 102 consecutively treated patients with penetrating hepatic injuries from 1972 through 1982 were reviewed. Fifty-five patients (54%) sustained gunshot wounds and 47 (46%) sustained knife wounds. The mean age was 29 years (range 3-71); 83 per cent were men. ⋯ Mortality was 2.9 per cent and all three deaths were secondary to bleeding from severe liver and associated vascular injuries. The low incidence of hepatic resection and mortality in this series of patients is attributed to the conservative management of liver injuries, adequate drainage, the use of a tamponade technique with multiple Penrose drains for through-and-through liver injuries and the expeditious repair of the vascular injuries. This paper includes a detailed description of the tamponade technique.
-
The American surgeon · Jan 1984
Case ReportsAcute reaction to protamine. Its importance to surgeons.
Three open heart surgery patients developed noncardiogenic pulmonary edema after administration of protamine following cardiopulmonary bypass. A catastrophic series of events are characteristic of this reaction: 1) sudden onset; 2) severe bronchoconstriction with early extreme difficulty in ventilation; 3) hyperinflation of the lungs; 4) pulmonary hypertension with normal pulmonary wedge or left atrial pressures; 5) progression to fulminant noncardiogenic pulmonary edema; 6) significant mortality; and 7) ventilatory perfusion abnormalities in survivors. Review of the literature reveals three types of reactions to protamine injection of varying severity: 1) brief hypotension; 2) anaphylactoid generalized reaction; and 3) high protein noncardiogenic pulmonary edema with cardiopulmonary collapse. ⋯ Awareness of this reaction is essential for prompt treatment if fulminant pulmonary edema occurs. Administration of epinephrine, steroids, vasopressors, and potassium replacement may be required. Needless use of protamine sulfate should be discouraged.