J Trauma
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The deep perineal laceration indicates major pelvic injury, especially when associated with pelvic fracture. Survival requires hemostasis, which must be established early by whatever means necessary, including emergency hemipelvectomy if required. Twelve patients with deep perineal laceration are reviewed. ⋯ Late deaths were related to infection in the pelvis. Prompt totally diverting colostomy with irrigation and disimpaction of the defunctionalized rectum and primary repair of urethral injuries are essentials in avoiding septic complications. A technique of rapid totally diverting colostomy that facilitates distal washouts without wound contamination is described.
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Shock or acute respiratory failure developing soon after chest trauma are associated with extremely high mortality and morbidity rates. In a study of 1,136 patients with chest trauma admitted to Detroit General Hospital during a 2-year period (1974-1975), it was found that 218 (19%) had shock or acute respiratory failure when first seen in the Emergency Department. ⋯ No patient over 45 years of age survived this combination. Efforts to improve results following chest trauma must be directed toward earlier and more aggressive management of both these problems
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Hypervolemia with hypertension often occurs 36-72 hours following massive blood and fluid replacement for hypovolemic shock. This syndrome of "fluid overload" has been attributed to the rapid intravascular flux of previously sequestered fluid in patients with impaired diuresis. This hypothesis was tested in 35 injured patients who received a mean of 9.3 L of blood and 17.4 L of salt during resucitation. ⋯ Patients with post-traumatic "fluid overload" appear to have a combination of hypervolemia, respiratory insufficiency, hypertension, increased cardiac output, decreased extracellular fluid space, and decreased renal perfusion. These findings suggest that decreased interstitial fluid space compliance rather than "fluid overload" is the underlying factor leading to respiratory insufficiency. The therapeutic aspects of these findings are discussed.