J Trauma
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Comparative Study Clinical Trial Controlled Clinical Trial
Rapid volume replacement for hypovolemic shock: a comparison of techniques and equipment.
The achievement of a very rapid fluid infusion rate may be critical in the resuscitation of the patient in hypovolemic shock. We studied flow rates of crystalloid and whole blood through various intravenous catheters and tubing systems. The 10-gauge Angiocath and the 8 Fr pulmonary artery introducer catheter provide flow rates equivalent to intravenous tubing (3.2 mm I. ⋯ Substantially higher flow rates can be achieved with the use of large-bore intravenous tubing (5.0 mm I. D.) connected to these catheters in place of standard intravenous tubing, allowing the infusion of 1,200-1,400 cc/minute of crystalloid and whole blood into the patient in hypovolemic shock through one intravenous catheter. Clinical trials with larger bore intravenous tubing are probably indicated.
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Objectives of temporary descending thoracic aortic cross-clamping for exsanguinating abdominal hemorrhage are to redistribute intravascular volume to the myocardium and brain, and to limit further blood loss. This report describes our experience with left thoracotomy and descending aortic occlusion (T/AO) performed in the operating room (OR) for massive hemoperitoneum. During a 5-year period, 39 (5%) of 791 patients undergoing laparotomy for acute injury required T/AO in the OR. ⋯ Only two patients, however, had pulmonary problems associated with T/AO; and both were minor (atelectasis and recurrent pneumothorax). In our experience, T/AO in the OR is successful in salvaging nearly one third of patients with life-threatening abdominal hemorrhage. The procedure can be performed rapidly, safely, and with minimal late sequelae.
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Distal interphalangeal joint dislocations of the fingers are uncommon but easily reducible. Irreducible dislocations are quite rare and treatment of such a case is being reported here. Causes of irreducibility have been found to be: volar plate interposition, protrusion of the middle phalanx through the joint capsule, and flexor tendon displacement over the middle phalanx. When these situations occur open reduction is indicated.
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Shotgun wounds present specific challenges for the surgeon. Multiple penetrating wounds frequently involve large anatomic areas with potential multi-system injury. Experience with 121 patients sustaining shotgun wounds over the 5-year period ending 31 December 1981 was reviewed to assess results and evaluate treatment protocols. ⋯ Five had major vascular injuries. Preoperative arteriography was obtained in 13 patients with extremity injuries; the results of one of these were falsely negative. There were no deaths or amputations.(ABSTRACT TRUNCATED AT 250 WORDS)
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A review of 62 consecutive patients who sustained flail chest after trauma from 1971 to 1982 was conducted to document the late effects of this injury. The mechanism of injury was motor vehicle accident in 44 (71%), fall in nine (14.5%), and farming accident in nine (14.5%). Patients ranged in age from 7 to 87 years. ⋯ Using the British Medical Research Gradation for Dyspnea, three (9%) patients had moderate and six (19%) severe shortness of breath. Objective dyspnea index calculated from VEBTPS /MVV revealed mild dyspnea in 50% and moderate dyspnea in 20%. Formal carbon monoxide diffusion testing was normal in 90% of patients and revealed mild decrease in 10%.(ABSTRACT TRUNCATED AT 250 WORDS)