J Trauma
-
Prehospital resuscitation and stabilization of major trauma victims is increasingly employed. To evaluate the benefits of one such maneuver, fluid administration, we reviewed 52 consecutive trauma cases in which patients had a blood pressure of less than 100 mm Hg either at the scene or on arrival to hospital. ⋯ A percentage of patients with correctable surgical lesions might have been salvaged had prompt transport been instituted. Field maneuvers in critically injured patients should be minimized to decrease ultimate mortality.
-
The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. ⋯ Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.