J Trauma
-
A retrospective analysis of 3,500 helicopter missions revealed 20 patients who required cricothyrotomy in the field for emergency airway access. Five patients who were in cardiopulmonary arrest succumbed despite cricothyrotomy, all with adequate airway control (Trauma Score, 2.8; ISS, 55.6). Seven of 12 patients with oral, maxillofacial, or cervical trauma survived (Trauma Score, 9.6; ISS, 48.25). ⋯ Autopsy revealed no serious airway pathology or compromise in those who expired. Surgical cricothyrotomy can successfully be performed in the field by a nurse/physician helicopter transport team. When conventional airway maneuvers are unsuccessful we recommend cricothyrotomy for emergency airway access.
-
Case Reports
Coverage of acute vascular injuries of the axilla and groin with transposition muscle flaps: case reports.
Acute axillary or groin vascular injuries caused by farm machinery or shotgun blasts are often associated with extensive soft-tissue loss. Coverage of the repaired blood vessels with healthy tissue is necessary to avoid infection, desiccation, pseudoaneurysm, and rupture. Adjacent muscles are not always available to rotate for coverage, due to unacceptable functional loss, or injury to the principal vascular pedicle. ⋯ Followup ranging from 9 months to 5 years revealed no vascular failure or soft-tissue complications. We conclude that coverage of vascular repairs and soft-tissue defects with viable muscle is necessary in cases of extensive injury. Adjacent muscle is preferred for coverage, but when this is unavailable, coverage can still be achieved using more proximally pedicled muscles of the trunk.
-
There has recently been an increased interest in the use of hypertonic solutions for fluid resuscitation of trauma victims. In this study, we examined the acute cerebral effects of a hypertonic lactated Ringer's solution (measured osmolality = 469 mOsm/kg) in an animal model of traumatic brain injury. Following the production of a cerebral cryogenic lesion, eight New Zealand white rabbits were randomized to undergo hemodilution with either lactated Ringer's (measured osmolality = 254 mOsm/kg) or hypertonic lactated Ringer's. ⋯ Brain water content was significantly increased in the region of the lesion as assayed by both the wet/dry weight method and cortical specific gravity determinations, but there was no difference between the two treatment groups. Water content of the nonlesioned hemisphere was significantly less in the hypertonic group. This study suggests that hypertonic saline solutions may be useful for the resuscitation of hypovolemic patients with localized brain injury.