J Trauma
-
Hypertonic saline treatment of hemorrhagic shock (HS) results in increased systemic blood pressure, cardiac output, and splanchnic blood flow. To determine whether this elevation in blood pressure and flow would augment blood loss from injured intra-abdominal vessels and thus enhance mortality rate, "controlled" HS was induced by bleeding of 20 ml/kg from an arterial cannula that was immediately occluded after hemorrhage, and "uncontrolled" HS was induced by incision of three major radicals of the ileocolic artery leading to continuous intra-abdominal blood loss. Seventy rats were divided into eight groups: Group I (n = 5) underwent carotid artery and jugular vein cannulation and was observed for 3 hr; in Group II (n = 10) "controlled" HS was induced by arterial hemorrhage of 20 ml/kg; in Group III (n = 7) "controlled" HS was treated by 5 ml/kg NaCl 0.9%; in Group IV (n = 8) "controlled" HS was treated by 5 ml/kg NaCl 7.5%; in Group V (n = 4) midline laparotomy and identification of the ileocolic artery was performed; in Group VI (n = 9) "uncontrolled" HS was induced by incision of three major branches of the ileocolic artery; in Group VII (n = 9) "uncontrolled" HS was treated by 5 ml/kg NaCl 0.9%, and in Group VIII (n = 18) "uncontrolled" HS was treated by 5 ml/kg NaCl 7.5%. In untreated "controlled" HS (Group II), mean arterial pressure (MAP) fell to 35 torr followed by a spontaneous rise to 62 torr (p less than 0.001) after 3 hr with a survival of 80% of the animals.(ABSTRACT TRUNCATED AT 250 WORDS)
-
This study was designed to assess the accuracy of the urine dipstick and its ability to predict injury to the urinary tract when compared to routine urinalysis: 1,485 patients had dipstick and microscopic urinalysis performed as part of their evaluation for blunt and penetrating trauma. Dipstick analysis was recorded as either positive or negative. Microhematuria was defined as greater than 0-1 RBC/HPF on microscopic analysis. ⋯ There were no cases of a missed injury in the group of 100 false negatives. Cost savings by conversion to the use of dipsticks would have saved our institution about $63,000 per year. It is concluded that the urinary dipstick is a safe, accurate, and reliable screening test for the presence or absence of hematuria in patients sustaining either blunt or penetrating abdominal trauma.
-
A microcomputer system was developed which allows the user to draw the contour of a burn on a diagram on the computer screen. The per cent body surface area is then determined by direct area measurement by the computer. ⋯ Excellent correlation between the computer system and the manual Lund and Browder chart method (correlation coefficient, 0.962; p less than 0.0001) was obtained. Computerized planimetry provides a rapid, simple method of recording data and calculating total per cent burn which compares well with the manual Lund and Browder diagram.
-
The size and depth of burn and patient age are useful early prognostic indicators in burned patients, but have limited value in predicting which patients in a given cohort are likely to die. The objective of this study was to identify additional variables in the first 10 days of burn injury which could better predict patient outcome. Variables consisting of demographic information, routine laboratory data, and clinical observations on 89 burned patients (63 survivors and 26 nonsurvivors) were analyzed. ⋯ The regression analyses revealed that, as previously demonstrated, patient age and burn size were significant predictors of mortality on admission and throughout the first 10 days postburn. In addition, absolute monocyte count (AMC), absolute lymphocyte count (ALC), maximum daily temperature (Tmax), and BUN were also significant predictors (p less than 0.05). These data indicate that logistic regression models can identify simple prognostic variables in burned patients which may improve clinicians' ability to identify high-risk patients early in the course of their burn injuries.
-
There is continuing controversy over the use of Advanced Life Support (ALS) in the treatment of multisystem injury. In this study, performed to define the role of ALS in the management of motor vehicle accidents (MVA), 538 ambulance run reports (ARR) and hospital records of patients involved in MVA in South Carolina for 1983 were examined. Of these, 248 were reviewed in depth by a trauma review committee (TRC). ⋯ Thirty-two per cent of ALS patients demonstrated an increased blood pressure en route compared to 12% of BLS patients. The TRC felt prehospital care was beneficial in 85% of cases, while 11.7% had inappropriate or inadequate care. Resuscitation and ALS in MVA appears to be beneficial in the treatment of multisystem trauma in a rural state.