J Trauma
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Randomized Controlled Trial Clinical Trial
The effects of inflation of antishock trousers on hemodynamics in normovolemic subjects.
Antishock trousers may maintain mean arterial pressure in trauma patients by increasing central blood volume and cardiac output. Hemodynamics, end-diastolic volume, stroke volume, cardiac output, and blood pressure were recorded in eight supine, healthy men in antishock trousers using two-dimensional echocardiography. Two inflation protocols were used. ⋯ The study shows that the antishock trousers alter several hemodynamic parameters. With lower inflation pressures, antishock trousers cause an increase in arterial pressure by increasing peripheral resistance. At higher inflation pressures, the antishock trousers increase cardiac output and as the cardiovascular system adjusts, maintain the pressure by increasing peripheral resistance.
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Ten patients with blunt heart rupture arrived in our emergency center alive during an 11-year period ending in 1984. Ages ranged from 19 to 65 years (mean, 35), and seven patients were male. Six patients presented with tamponade, three with hemorrhagic shock, and one with combined symptoms. ⋯ Seven patients survived. Three deaths were due to irreversible hemorrhagic shock, two secondary to heart injury, and one from an associated liver injury. Prompt pericardial window with subsequent median sternotomy was successful for patients presenting with tamponade and immediate thoracotomy for those bleeding into a pleural cavity.
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We present two cases of delayed, massive, life-threatening hemothorax due to intercostal hemorrhage in association with fractured ribs and severe blunt chest trauma (SBCT), a combination we have not seen described in the literature. Blunt chest trauma is not benign. Significant intrathoracic injuries are frequent although usually not life threatening. ⋯ However, rapid blood loss requires immediate open thoracotomy and surgical attention. Several days of observation in hospital may be required for patients with SBCT and fractured ribs even without any other obvious intra- or extra-thoracic injuries. Vigorous activity or chest physical therapy may be dangerous during the first several days after the injury.
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Serum creatine kinase isoenzyme (CK-MB) screening followed by two-dimensional echocardiography (2-DE) was used for the assessment of possible cardiac injury in victims of blunt trauma with acute thoracic or rapid deceleration injury. Of 291 victims evaluated acutely, 58 (20%) had a CK-MB fraction evident within 24 hours after injury. ⋯ Distinction between concussion and contusion has enabled development of a rational acute management protocol. A total of 70 patients with documented blunt cardiac injury (58 evaluated acutely, nine dead on arrival or died in the emergency room, and three delayed presentations) seen at this institution over 4 years are reported, illustrating the full spectrum of blunt cardiac injury.
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A 5-year experience with 12 sternal fractures treated at the Los Angeles County Harbor/UCLA Medical Center is presented. Our data indicate that sternal fractures with roentgenographic mediastinal widening commonly have associated aortic injuries. There is an almost uniform depression of right ventricular or anterior left ventricular function associated with sternal fractures and these cardiac sequelae are documentable by first-pass biventricular radionuclide angiography including left ventricular segmental wall motion analysis. ⋯ In contrast, the incidence of displaced or unstable fractures is very low. Only one patient in this series had a depressed manubriosternal fracture, and no injury necessitated surgical stabilization. The outcome of isolated sternal fractures is benign, and they should be viewed as harbingers of the discovery of other injuries.