J Trauma
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Assessment of splanchnic perfusion by gastric intramucosal pH (pHi) adds to the information provided by systemic indicators of oxygen transport. ⋯ Uncorrected splanchnic malperfusion is associated with a higher incidence of organ dysfunction and mortality. Gastric tonometry supplements information provided by systemic indicators of oxygen transport during resuscitation of critically ill trauma patients.
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Controversy exists whether early aggressive fluid therapy in the setting of uncontrolled hemorrhage worsens outcome by increasing blood loss from injured vessels. Since diaspirin crosslinked hemoglobin (DCLHb) is a vasoactive, oxygen-carrying solution, we compared the effects of DCLHb with other resuscitative fluids on blood loss, hemodynamics, and tissue oxygen delivery in a model of uncontrolled hemorrhage. Anesthetized rats (250-350 g) were subjected to a 50% tail transection and resuscitated 15 minutes later with 1:1 DCLHb, 3:1 lactated Ringer's solution (LR), 1:1 hypertonic saline (7.5% HTS), or 1:1 human serum albumin (8.3% HSA) based on initial volume of blood loss (average 4.7 +/- 0.3 mL/kg). ⋯ Although blood loss in DCLHb-treated animals was greater than in unresuscitated animals, it was no different from other resuscitative fluids and less than with HSA. There was no difference in 24-hour survival between all treatment groups. In conclusion, DCLHb elevates MAP but does not exacerbate blood loss or compromise tissue oxygen delivery compared with other resuscitative fluids in this model of uncontrolled hemorrhage.
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Recent work suggests that increased intracranial pressure (ICP) following brain injury and shock is related to increased central venous pressure (CVP) following resuscitation. ⋯ These data suggest that brain edema formation in the injured hemisphere is related to MAP and not CVP, but variability in MAP accounts for only 29% of the variability in CWC and ICP, suggesting the importance of factors other than hydrostatic pressure in determining the amount of edema and the ICP after brain injury. Previous work demonstrating the significant correlation of polymorphonuclear leukocyte infiltration with ICP (r = 0.71, p < 0.001) and with CWC (r = -0.63, p < 0.001) suggests that inflammation may be one of these factors.
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Extremity amputation is a devastating injury. Forty-two patients who sustained traumatic limb amputation were contacted 3-57 months (mean, 25 months; median, 24 months) after injury to evaluate residual disability and to determine what factors were associated with a good recovery. There were 35 men and 7 women with ages ranging from 5 to 73 years (mean, 34 years). ⋯ No patient with a AK amputation and only 1 (9%) patient with a work-related injury returned to work. Associated injuries or inpatient rehabilitation did not correlate with returning to work. Eighty-eight percent of patients were satisfied with their adjustment and could perform all activities of daily living.(ABSTRACT TRUNCATED AT 250 WORDS)
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In three patients with elbow dislocations after falls on an outstretched upper extremity, concurrent perilunate dislocation was found. Closed reduction of the elbow dislocation achieved excellent functional results. Open reduction and internal fixation for perilunate dislocation provided anatomic reduction and satisfactory functional recovery in two patients. In the third, a delay in diagnosis of a perilunate dislocation necessitated proximal row carpectomy at 6 weeks.